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Home My WebLink About19010-Z I~R~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_* i 90t0 Z / Date ....... Permission is hereby g_ranted to: ................................................... ............................................ ~c~t¥ Tax Map No. ~000 Sectian ............. B]c~k .......... /....,~., .... Lot No....,,,~,~. ............... pursuant ,o application dated ...... ...~-../.~... ................................... , 197..~..., and approved by the Building Inspector. Fee $....../.. C~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD. N.Y. 11071 TEL.; 755.1802 BOARD OF HEALTIt ............ 3 SETS OF PLANS ............ SURVEY ..................... CllECK ...................... SEPTIC FORH ................ Examined ?-~' .......... 19 Disapproved ale .......................... ....................... · .g p ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tills application must bc completely filled in by typewriter or in ink and submitted to the Building~ InSPector, with 3 sets 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 prcmis~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whichi~part of this appii- cat/an. ~ The worlc covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Buildir~g Inspector ~vfll issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ¢. No building shall be occupied or used in whole or in part for may purpose whatever until a Certificat~ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm/t lmrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. The applicant agrees to d6i~lY With all'applicable laws. ordinances, building code, housin~- code, and regulations, and to admit authorized i~lspe_ct~o .1~, O~t pr~mises and in building for necessary inspccti~fl))s. /~/~ ,~ r~~ ,~- ; ',~ ; . (Signature ~j~hpplica~t,'" '~'~ or nami. if:i corporaI~on) · , . ~. ............. .;.~/7 3?-',VF. ~ - · (Mailing address of applicant) State whether a~t~i~ awr~r, qessee,,.agent~i architect, engineer, general contractor, electrician, plumber or builder. thc tax roll or latest deed) Builder's License No .... ~..~...~r~ .... Plumber's License No Electrician's License No ................... . .. . O/her Tradc's Licensc No .. . Location of land on which proposed work will bc done; llouse Number ' Street Hatnlet CountyTax MapNo 1000Se t/on .//.~. BIo k ./.), Lot .~. Subdivision Eiled Map No Lot ...... __.tNa,,;J~ ............. " ........................... State existing usc and occupancy of premises and in tended use and occnpancy of proposed construction: a. Existing usc and occupancy ................................. - · ; .,.';.~ ...................... bl d · men cd Use ando anc ..- · ..... -' ............. ccup y . - Repair .............. Rbmova! .............. D~molitlon . L/<-' ....... s~ti~rn ,.n~-----~{ ......... ' Tennis Court ......... Accessory Building .......... Fence ....... Other l~ork ............ ,I.. Estimated Cost ...................................... Fee ..................................... ' (to be paid on filing this application) $. If dwelling, nt:znber of dwelling units ............... Number of dwclliug units on each floor ................. If garage, number of cars ........................................................................ /~. If business, commercial or mixed occupancy, specify nature and extent of each type of usc ................ ' .... 7. Dimensions of existing structures, if an),: Front ............... Rear ............... Depth ................ Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .............. ' Depth ...................... I-fright ...................... Number of Stones ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... NUmber of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth .................... . · 10. Date of Purc,~ase ............................. Name of Former Owner ............................. 11. Zone or Use district in which premises are situated ...................................................... 17. Does proposed Construction violate any zoning law, ordinance or regulation: ................................. 13. Will lot be regraded .: .......................... V/ill excess fill be removed from premises: Yes .... No. 14. Name of Owner of premises ................ ' .... Address ................... Phone No ................. Name of Architect ........................... Address ................... Phone No ................. Name of Contractor ................. .' ........ Address ................... Phone No ..... .". ..... J .... 15.15 thi:~ property' l. ocated ~i£hin lO0 feet of a tidal wetland? eYES .... NO .... · If yes, Souchold To~'u Trustees Permit may be required. PLOT DIAGRAM Locate clearly and dist/nctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descr/ption accord/rig to deed, and show street names and indicate whether interior or comer lot. APPROVED AS NOTED NOTIFY 8131LDINiS FOLLOWING INSPECTIONS: I. FOUNOATON - ~ REQ~RED FOR POURED CONCR~ 2. ROUGH - ~AMING 4. FINAL ~N~U~ BE ~ F~ C.O. & oe STATE OF NEW YORK, S.S COUNTY OF ................. .......... being duly sworn deposes and says that he is thc applicant (Natne of individual signing contract) above named. He is the · ' (Contractor, agent, corporatc officer, etc.) of ~aid owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application: that all statements contained in /his applicqtion are true to thc best of his knowledge and bclicf; and that the worJ~ w/Il be performed in the manner set forth in thc application fHcd therewith. Sworn to before mc this , i.~ ................. dayor ..... .......... l 7.q ........ ,- (Signature of applicant)