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Home My WebLink About18839-Z lt~Om~M' NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- 18839 Z Permission is hereby granted to: ~)~. ~...~- v , ..O~~..~..:....!./.~...?. ............... , ,--,, at ~rem~ses ~a~ed,~..,~.~.~.~ ........ ~.~.....~.....: ......... ~ ......................................... County Tax Mop No. 1000 Section ....... ..~...]...~. ....... Block ...... .(~...~. ....... Lot No..]~.,.J. .............. pursuant to application dated ...~~......~...~. .............. , 19.~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 BLDG. DE · LD ~1 L.._._TOWt~,' OF SOUTHO J, FORM NO. 1 TOWN OF SOUTHOLD BUILDING OEpARTMENT TOWN HALL ~OUTHOLDo N.Y. 11971 TEL.: 765-1802 BOAgD OF HEALTH ............ 3 SETS OF PLANS SURVEY ..................... CHECK ...................... SEPTIC FORM ................ . %., 19?P. Pea. it No.. l Approved Disapproved ale ............................ . . .. ... . . .................... (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY; CALL ..................... MAIL TO: · Date ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to thc Building/~ector, with 3 mt~ 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 premise: or public streets ar areas, and giving a detailed description of layout of property must be drawn on the diagram which i~ part of this appli- :ation. ¢. The work covered by this 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 permit ;hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for may purpose whatever until a Certificate of Occupancy :hall have been granted by the Building Inspector. APPLICATION IS HEREBY' MADE to the Building Department for the issuance of a Bu/Iding Permit pursuant to the ]uild/ng Zone Ordinance of the Town of Southold, Suffolk County, New York, a.nd other applicable Laws, Ordinances or ~eaulations; for the construction of buildings, additions or a to,rations, or for ~emoval or demolition, as he.in described. 7h~ applicant agrees to comply with all applicable laws. ordinances, building code, housin- code, and re~tafions, and to dmit author/zed inspectors on premises and in building for necessary in~s~ections. .. / _ (Signat, ffre o~ appl cant, or name, :f a corporanon) , ~ (Mailing address of applicant) tatc whgther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on thc tax roll or latest deed) 'applicant is a corporat{~Q~Z~t~l~*~?~ authorized officer. Elcctrlclan $ License o .......... · ..~., ~.~ Other Trade's Linen · ./~...;. .....~.-. .......... Location of land on which proposed work will bc done; tlouse Num ~er ' Stree[ ' ' Count>, Tax M~p No. 1000 Section .... ~ .. : ..... BlOck ............... Lot ......... Subdivision .. Oiled Map No ............. Lot .............. (Name) ...' ;tare existing usc and occupancy of premises and intended use and occupancy of proposed constrttction: ~. ExJstin?) USe and OCCUpancy ............... "¢ ........ ' .............. ~. ]mended us~ ~nd occupancy - · · ' ...... Hamlet · Narurc of work (check which applicable): Hew Uuilding ....... Ad,t;t;~,~ ' ~Ii~ ...... ~ · · - ~e~ce ....... Other Wock~ · (to bc paid on filing ~his aPpl~tion) If dwelling, number o~ dwelling units ........... Number or -~ ...... ]f~. numbcr of~ '~'~'~. -uwc.mg umts on each floor ........ It business c · · ~' ~ .............. ~smcnsron~ of cxistin- s. ........ .o __ ~' - -~ ...... a.u cx[cnt o[ each type of usc ,.~ns,on, o,same s,mc,urc w.h alterations or aaditiods~ ~ ........................................ Depth ................ Hci~t ....... ................... Rear .... Number of Stoics .... mcnsion~ of entire new c~nstmcfion: Front · · Height . N · · Rcar .. . Devth zc ol lot: ~ront · ' ......... Rca~ .... · .... - - ' ntca P-cruises are ~ituatcd .................................................. ... :. Dots propo~d co.traction violate a~y zonin,-law ordi n '. Wflllotbere.~-a ~z~ - ~ , na CC or regulat~on- ~ ol Owner of vrcmis,~P~,~vS~'l' {% ' '~' ~.~)wi{ exce~ fill be rcmov'dd from premise~: ~c of Architect . -~ ........ ~- · · -, ......... Addre~ ............ Phone No PLOT Locate cie~ly ~d dis~ctl~ ~l bu~d~, whether ex/sting or Proposed, ~d. indicat~ ~1 set-back d~ensions from 'o~e~y Hnes. Give street ~d block number or de~c~ption aecord~g to deed, ~d show steer n~ and ~i~l~ tenor or comer lot. · TATE OF NEW YORK, 'OUNTY OF a~ ndiv u signin,. ' .... e is thc ... , · ALL CONSTRUCTION SHALL MEET ............................ '.' ' rile ar-OUmE aENrS tHE N.Y. .' ...' ..... ~) NOT RESPONSIBLF FOR f safd Owner or ownc~. ~d is duJy authorized to perform or have perfo~s~ ~TION ERRORS ~Plicafion: that all slatements contained ia thi~ appl/coIJon are trtze to thc best of his knoxvlcdgc and belief;and that thc ork ~vdl be perfbnned in lite m~ner set for/h in thc application qlcd therewith. ,~ anu [o m~e and ~Z~ this .yom to before mc lifts ' · HEL~ IL DE VOE · 8 8, Suffolk Term Expires M~'ch 3Ik~f (SignatUre of applic:mt)