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Home My WebLink About18385-ZTOWN OF SOUTHOLD IUILDING DEPARTMr'NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 18385 Z Permission is hereby granted to; __ / / /2 ,,~ ,~ . .. ...... ~..~,/,,.z~z .......... =t premises loc=ted at ...~.~..-~..~ .......... . .~.¢g/.~.~'.......'~.,.'~.' ................................................................. cou.~ Tox Mop No. ,000 Sec,io. .......... ./..~. ...... 8,~k ............. /. ..... Lo~ No .......... ~ ........ pursuant to application dated ........ .~.../..~...~.. ................................. , I9.(~..~., and approved by the Building Inspector. u~g In,~ector Rev. 6/30/80 FORM ~0. ] TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH .......... 3 SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORM .............. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with .:-'ts of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public strce ar aregs, and giving a del:filed description of layout of property must be drawn on the diagram which is parr of this app :~tion. ¢. The work covered by ti'tis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm skull be kept on the premises avaUable for inspection throu_--3tout the work. e. No building shall be occupied or used in whole or in part for agy purpose whatever until a Certificate of Occup:mc -'hall have been granted by ~c Building Inspector. .. APPLICATION IS HEREBY MADE to the Building Depm-tment for the issuance of a BuiIding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Rc_,gulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr~bec Tile applicant agrees to comply with all applicable laws. ordinances, building code, housin~ code, and regulations, and n admit author/zed inspectors on premises and in building for necessary insp,~t~ns. . j _ (Signature/~£ applicant, or name. if a corporatmn) (Mailing address of applicant) .... State 'whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~...~. ¥,e. ~.~..L .<~.. .............. .,, i ...................... arne o OWnCr rcm scs ........................... (as on thc tax roll or latest deed) :£applicant is a corporation, signature of duly authorized officer. Budder s Lic:nse No .......................... Plumber's License No License No ....................... OthcrTradc% License No. .... .............. . .. will bc done ' ' Location of land on which proposed work ........................................... J[ous~ Number Street. Hamlet County Tax Map No. 1000 Sccdon ............. Bluck ................. Lot Subdk'ision Filed Map No Lot ....... (Name) Sl~le c.xi~ n~ I sc and occupancy of ~em~cs and intended use and oCCUpancy of proposed construction: . ...... ..' ...... : .... ... $. Nature otwork (check which applicable): New Building ..... ' ..... A~ ........... 'dtcratlon ..... Repair .............. P, cmoval .............. Dcmobtion ........... Olher \Vork ...... ' 4. Esrimatdd Co~t .................... (to be paid on ~ling ~his application) $. IFd~vclEng, number oF dwclling units ............... Numbcrofdwclling unitson cach floor ..... ]~ gnr2~e, number of cars ................ ' ....... 6 lib ............................. ' ' ' '''' ''' ' ' ' ' ' ' . usmcss. COmmercial or mixed occupnncy, spccily nature and cx~cnt of each typ~ of us~ ................. 7, Dimcnsi°ns°fcxisringsLmc~s~i~any:. . Front .......... . . ... Rcar ............ ... Depth .. ........ . ~ 0f ~am: st~cturc wi[b altcration~ or additions: Fr~ ...... Depth ' Dimensions of~-~w const~ctlon-Front H~c~t_ - - · ..---.--.... Nmnb~r of Sto~ ....................................... Rear . . D~pth . 9. Size otlot: ~ront ...................... Rear ...................... Depth amc of Fo vnet ............... Does. proposed construction violate any zen ng law, ordinance or regulation' . . ' ...... ~* ........................... Will ' ' ........................... ' 13. %~ lot be r""raded excess fill be removed from premise~: 14. N~e of Owner of premises ........ · N f A .......... Address ................... Phone No .......... ~e o rchitccr ................. Address ................ Phone No ..... N~e of Contractor .......................... Address ................... Phone No ........ ' .... i.. 15.Is thi~ properr7 located wirhin200 feet of a tidal ~erland? ~YES .... HO .... ~If yes, SouEhotd Toun Trustees Permit may be required. PLOT DIAG ~M Locate cle~ly ~d dhtLnctly ~1 bu~d~gs, Whether existing or proposed, ~d. indicata ~1 set-back dLm:n~ion~ mI:norPr°Pe~Yor~aes'comerGiVelot.streer ~d glozk number or desc~ption according to deed, ~d show street nmos and md..ale' ?ATE OF N E¥,'rY'D~K, BU?TY OF~ (~ sig~ng contract) ......... being duly sworn, deposc, s ;md says that ore :aid owncr or ' - "' P o have performed the said work and tempe I owners, ~d s duy au~mrizcd to crform r ~hcal)on; th:t all statc)ncnts containud in lhJs nppDcat~on sro truc to the best of his knowledge and belief; and Omt thc :k wdl [c performed in the m~ncr set forth in thc application filed therewith.