The URL can be used to link to this page

Home My WebLink About19679-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERM(T MUET BE KEPT ON THE PREMISE5 UNTIL FULL CONIPLETION OF THE WORK ^UTHORIZED) Permission is hereby granted to: // I ~ ~ ~ .... ~..~....~..~~ ..... at premises located ~t ..........~.....~....~../.~.....~....~,~/'.~.....:~..~ ...................................... County Tax Mop No. 1000 Section ........ ~..~... ...... Block ...... /.. ............. Lot No.../......~. .............. .u~uon, ,o o~,,~o,,o. ~,~ ...... . .~.....~.. ......... ~..r- ....... , ".~/.. o,~ o~,~ ~,~. Building Inspector, ~'3 ~. ~....~.....,.~... Building Inspector Rev. 6/30/80 FO~iVl NO. 1 TOWN OF SouTHOLD {aUILDING O EpAFITIVI ENT TOWN HALL TEL,: 705-1~02 BO,\KO OF HEALTH ......... 3 SETS OF PLA~S .......... SURVEY CIIECK ........ Examined ................. 19... ^,p,o,.ed .... Disapp.roved ale ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT CALL ................... HAlL TO: INS'I'F. UCTIONS a. This application must be completely filled in by typewriter or irt ink had submitted to the Building la:pc, star, ;ets Of pl~r~, ~renratc plot plan to scale. Fe= =c'~on:fing to schedule. b. Plot plan sho~ving location of lot and of buildings on premises, relationship to adjoinin*= premise= or public strc: =r areis, and giving a detailed description of layout of property 'must be df:aS, va'on thc diagram which is pa~ of this :ation. c. The work covered by this application may not be commenced before issuance of Building Permit. ~I. Upon approval of this application, the Building inspector will issued a Building permit to the uppiicant. Such ih:Ill lo. kept on the premises available for inspection ~hrouchout ~he work. c. No building shlill bc occupied-or used in whol~ oran par~ for a.ny purpose whatever until a Ccrtificat~ of ;hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to thc Building Department for the issuance of a Building Pe..-:ait .='-'r'~.mnt to tuilding Zone Ordinance o£ the Town of Southold. Suffolk County, New Yorl,', and other applicable Laws, OrdLn::mces ~,c:uIations. for the construction of build[q~=s, additions or alterations, or for removal or demolition, r.s herein describe: Fha- applicant agrees to comply with all applicable laws, ordinnnccs, building code. housin= cod-', ann r:g,.:'lations, and :dmit authorized inspectors on premises and in bulldog for necessary inspections. .... .?. ..... {SignatUre of a~licant, or name. ua ~or~o ~ i ...... ~Mailing add~'~x of apl:~C~nt) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder . {amc oiI owner or premises . * ..... '- ~ (as on thc tax roi orlat stdee~ applicant is a corporation, signature of duly authorized offi¢cr. Plumber's License No Eicctricbn's Liccn=c No ....................... O/her Tradc's Liccn:e No ....... ~ Location of land on which proposed work will be done: 'q / /i F. · l[ousc Numbcr Street Hamlet ' ' Coun,y Tax Map No. lO00 Section ..... ~-.~" ..... : Block ...... [ ........... Lot,..[..~ ....... ,.-- Subdivision ..................................... Eil~d Map No. . ............. (Name) ~l~l¢ exisHng .~c and occupancy or premises and in~cndcd ,sc u.d occ}~p~ncy or propo;ed construction: ~xlsting usc and ~/ ~.-~~~.,~~ >/, ~ ~...,..... .... ..-- .,: . B. 'Intende8 use. and occupancy.; "'~"~''' . ..- .~.~ :~ . , · 3. Nature of ~vork (check which applicable): Ncw Building .......... Ad~ ....... ,Lll:cration . . . Iennis Court ......... Accessory ~uilding .......... Fence ....... Other ~ork, ......... (t~ be paid on filing this aoplication} 5. Irdwelllng nbcrofd tiling its Numb rofd its each~oor . nm w un ............... e wellit~g nn on ............. If garage, number of cars ............................ .......................... 7. ~'. Dimcnxion~ofexistingstmCtures, ifany: Front ............... Rear ............... Depth ............ Hci' - bt Number of Stones' ~o.i .=~ ........ Dimensions of same st~cture with alterations or addition~: Doeth ................ · -- . .. }lei~t .......... ... . .--- .... Number' 'ofStone~' .................... 8. Dimensions of entire new conxtn~ction: Front ............... Rear ............... Depth ............. Hci:ht... .. Number of Stohex 9. Si~e of let: Fiont ...................... Rear .................... Depth .............. I~. Dnte of Purchase ............................. Name orFo~er Owner ............................ 11. Zone oruxe district in which premises are situated .................................................. 12. Does proposed Construction violate any zoning laxv, ordinance or regulation: ............................... 13. W~I lot be regraded ................... - .. 1,1. N~e or Owner of pmm~ ............... j .... Addre~ . . . Phone No ............ ............. Addres* ..... Phone No N~e of Architect ................ N~e of ContraCtor. - -.. . ' Addrex* . . .. . Phone No ' lX.I~ [ki= property located uithin'lO0 feet of a tidal uetland? ~YZS .... NO .... ~I~ 7az, Southold Town Trustees Permit may be required. PLOT DIAG~M Locate clc~ly ~d dist~ctly ~I bu~dNg~, whether'existing or proposed, ~d. indicate prope~y ~nc~. Give street ~d block number or dexchption accord~g to deed, ~d show ~trecC nmex and ~dicatc wa::::. intehor or corner lot. being duly sworn, deposes and says that he is the applic::- (<(C. Loo'_~gent, corporate officer, ~t~.) - " said o ne ~ d I authorized to perform or have performed thc said work and to m~e and file 3PlJcalion: that all statements contaiucd in lhis application are /rue to the best of his knowledge and belief; and tlxat t:: ot~ tviH be perforated in tile m~ncr :et forth in thc application filed therewith. ,yom to beI'ore me thi~ .... . . - . ......... ...... . ~ .._ ~ "~', · .,i', , · (~ignatureof UUBI/tJ~ in Surfak ~u~ ~ 7/ ' ' ' ,~ rr 6Cc~/~: ~0'=1'' ~ = Ado~-~arrt¢,.lf t A'T ~OU?'HOLD 7d-{-- la