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Home My WebLink About19405-Z IeOB, M NO. ~ TOWN 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) N~ ~$40S Z Permission is hereby granted~ to: C~. ~ 0 · ......... ......... .... ~......~.:..~., ....... ,..,..~...~ .............. , ~d, .................................. ; ...... ~ ......................................... ~ ........................................ .: .................. et premises located mt ...~..,,~....~...... ,.~,..~.....~,..{~:.:.......~.~~ ........ pursuant ,o application dated ..... .~.'~....e~c,n~ ....... (.~ ......... 19.~..Q., and approved by the Building Inspector. Budding Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~- ,~/,,rT'?~c £ $OUTHOLD, N.Y. 11971 7 ~'~?'&/J TEL.: 7G5-1802 Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY~ CALL ..................... MAIL TO: Date . .~ .~,...~. ............ INSTRUCTIONS a. This application must be completely filled in by type~vr/ter or in ink and submitted to the Building Ihspector, with $ 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- caQon. c. 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. c. No building shall be occupied or used in whole or in part for aoy purpose whatever until a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, acl. ditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil[Ji~eg code, h~ code~, and regulations, and to admit authorized inspectors on premises and in building for necessary ins_~ tjons. ~?'~// / xO.<,',x&, - ............... r' / / _ __ /., <. ./__.~Signature of h'lSpt~ant, 6rtn'Wffie,,if a cgfporanon~ · ~ ............... '~'"~" ......... 2;'~;?~/'" ......... - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. , ................................................................... Name of owner o f premises... ~..~.0.~..~ .zT?~..~. '~.,]. z~ff.,r~- ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......' ~fg~me ........... and title o ~' ' 'r~co rate ..... o f~''cer') ......... Builder's License No ........................... Plumber's License No ......................... Elcctrzcmn s L~cense No ....................... Other Trade s Ltcense No ...................... I. Location of land on which proposed work will be done: ,q tlouse Number .~7 ,_..~t reef. County Tax Map No. I000 S~ction BlOck ............. Lot.. ?. ......... ~.. s.--,.,s,on ..... ................. ............... ............... (Name) XlSllflo usc and occupancy of premises and intended use an~ occupancy of proposed constrt ct on A. ~x~sting use and occupancy ~~.-~-~--.~:.-~-~,~.~ .............. ," ~,'/73'7/,~ ~ B. Intended use and occupanc,--~.U:~-''.:~ ..... <~~ ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... '. · Repair ........ i ..... Rbmoval .............. Demolition . .~K~, .......... Swim, ins pool ............. Term:ts Court: ......... Accessory Build:ms .......... (F~r~ce ....... Other !4ork; ........... 4. Estimated Cost ............ ...................... ... Fee ..................................... · · (to be paid on filing this application} 5. If dwelling, number of dwelling units .............. Number o f dwelling units on each floor ...... '..~ ...... If garage, number of cars ....................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front.., ............ Rear ............... Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories .............. : ............................. ' ........... 9. Size of lot: Front ...................... Rea.'- ...................... Depth ..................... 10. Date of Purchase ............................. Name of Former Owner ............................ 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 .... No.. 14. Name of Owner of premises ................ ' ....Address ................... 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 .... IlO .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly ~nd distinctly all buildh~gs, whethcr existing or proposcd, and. indicate all set-back dimensions from property lines. Give street and block numbcr or dcscfiption according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YQ,RK, COUNTY OF .~...J..~.~..~.,.~,'4J/~,/<.. S.S ........ ....... being duly sworn, deposes and says that he is the applicant (Name of individual signiog contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pc;form or have perfo~ed the said work and to m~e and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work w~l be pert~m~ed in the m~ner set forth in thc appticalioo filed therewith. Sworn to before me tl~is .............. ....... .