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Home My WebLink About19404-Z I~lJllJ NO. ~ TOW'II OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ '~40,': Z Date ...... ~ .................... 19..~..(~ Permission is hereby granted to: ....... ...... ~..~.l.~,~-.. ....... ~.....~......,~...,._~.. ....... .~.~~.....~.....V..,.....u.~.]..L.. premises located at ..... ~..~..1......,~ ...........~..~ ....... .~ ............ ~...~~ ......... County Tax Mop No. 1000 Section ..... /...6....,_~. ....... Block ...... ..O.....~.. ...... Lot No ..... J...~', ............. pursuant to application dated .... ...~. j~.~. .............. l...~ ................... , 19.1~....~.., and approved by the Building Inspector. Fee $..~...~....1...~.. Building Inspector Rev. 6/30/80 FORM NO. '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .... 197. . BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... NOTIFY~ MAIL TO: · · · BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR BI::tlt'Dfftt~'PERMIT INSTRUCTIONS a. Tlfis application must be completely filled in by Wpewriter or in ink and submitted to the Building Ihspector, 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 shall 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 agy purpose whatever until a Certificate of Occupa~ncy s'l~all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, ad~ditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with at1 applicable laws, ordinances, building code, housin~ code, and regulations, and to admit author/zed inspectors on premises and in building for necessary inspections. (Signature ot applicant, or name, if a corporatmn) ........... (M'ailing address of a;plicant) ......... State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................... Plumber's License No ......................... Electrician's License No ....................... Otlier Trade's License No ...................... ., 1. Location of land on which proposed work will be done: ...3. ............ [louse Number Street, Hamlet Countyrax Map No. ,000 Section ../.~...2,'..: Block "~ Lot // '~ ' Subdivision ..................................... F, ih:d Map No ............... Lot ............... (Name) 2. State existing usc and occupancy of premises and intended rise and occnpancy of proposed construction: B. Intended use and occupancy. ...... 3. Nature of work (check which applicable)'. New Building .......... Add. itia.~n .. · .~ .....Alteration, . . '. · Tennis Court: ......... Accessory Buildlng .......... Fence ....... Ocher Work: ........... 4 Estimated Cost '~/~/~ ' ' · . ........ o/ ........................... Fee ................................... . . (to be paid on filing this application} 5. If dwelling, numberofdwellingunits...............~ Numberofdwcllingunitsoneachfloor..~..~ .......... . If garage, number of cars. .... -. ............................................................... . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... ~ ........... 7. Dimensions of e.xisting structures, if any: Front.. ,~..~. ....... Rear ............... Depth ...~..~. ...... Height ... ,t./~.~. ...... Number of Stories ...... //.~.<.-~: ......................................... Dimensions of same structure xvith alterations or additions: Front .~ ............... Rear ................ Depth ~ Height ~ Number of Stories 8. Dimensions of entire new c0nstrnction: Front ~-' Rear ............... Depth . . . Heieht ~ Number of Stories ~ : ' 9. Size of lot: Front' ...~-~:~... ............... Rear .....,~.,~..~..o ............ De~th .... .:.: ........,,. .... lO. Date of Purchase ..../.ff..7.. ~. ..... , ............. ,~3ame of Former Oxvner ...Z..`. ~ ,~-.. ~.. ~....~... ...... 11. Zone or use district in which premises are situated .... ,.,. .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~...~. .......................... 13. Will lot be regraded ..................... ~. ...... Will excess fill be removed from premises: Yes . ~_~ .'-~' 14. Name of Owner of premises . .~-. 6-~.~-q../..r....e'j.~. e?,~Wd~ress ..... 7 ............. Phone No..~..~ ~.. ~.. ~.~ -... Name of Architect Address ~ . Phone No . . Name of Contractor .... ~ ................. Address ................... Phone No ..... 15.Is this property located within 300 feet of a tidal wetland? *YES---'-h'O'-'~ ~J~- · If yes $outhold To~n Trustees Permit may be required. · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NE~V YORK, S.S COUNTY OF ................. ................................................. being doly s~vorn, deposes and says that he is the applicant (Name of indMdual signing contract) above named. He is the ...................................................................................... ... (Contractor, agent, corporate officer, etc.) of said 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 this application are true to the best of his knowledge and belief; and that the Xvork xvill be performed in the manner set forth in the application filed therewith. Sworn to before me this