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Home My WebLink About19730-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/v~IT MUST BE KEPT ON THE PREN~ISF.~ UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N~ 197~0 Z Permission is .....F......~ ...... /J....~.. ............. L~J...~ ........... _ ....... .:~._..._.._~....~~...~ .. at premises located at ................ ~.~..~....~....~..~...,~.... ................................................ ~.....~.......a.....a...a....~..a.. ................................................................. County Tax Mop No. 1000 Section .~ ~,,.~..~,. .......... Block ....~,,,, ........... Lot No ........ ~ ........... pursuant ,o application datecl .............. ~_~L ........ ..~,. ......... , 19...~..Z and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHQ~.D~ TEL.: 765-1802 Exa,nincd · L'.//..., ^ppro,ed No.. L Z .,Z. BOARD OF HEALTH ........... 3 SETS OF PLANS ........... SURVEY ..................... CHECK ...................... SEPTIC FORM ............... : CALL ..................... MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely ffIled in by typewriter or irt ink and submitted to the Building I~p~tor, with ~ sets af plrtn% ace. urat¢ plot plan to scale. ,"'~ accon:Hng to schedule, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street.' 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 a0y 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 appIicable Laws, Ordinances or Re,,ulations, for the construction of buildings, additions or alterations, or for i:emoval or demolition, as herein described. TI~ applicant agrees to comply with all applicab~te laws, ordinances, building code, housin~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. State whether 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. Builder's Licansc No...~.~-..~. .............. Plumber's License No... ~¢. & ............. Electrician's License No.. ~, . .~ .'. ............ Olher Tr~dc's License No ...................... 1. Location of land on which proposed work ~vill be done: ..... ..... ?c. lIouse ~qu~;ficZ~'''' ~/''' ~ Street, ' Hamlet County Tax Map No. 1000 Section Block Lot .... ,... Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) 2. State existing use and occupancy of prcmtses and intended use aud OCCupancy of proposed construction. .. . .. ~ ~ .......... . A. EztstJng use and occupancy., · · -.- .... ; · · -, ........ -, ..... , ...... ' ' ' ' . B. Intended use aha occupancy ......... ~ ....................... ~' .............. 3. ~Nature of work (check whic~ applicable): New Buildin~ .......... Additi~c~n .......... Alteration ......... R~epair. ........ , ..... Rlemoval ............ Dcmolit on . ..'~. ...... SwL,'ra'ning pool ........... $~enn~_s Court ......... Accessory Building .......... Fence, ....... Other Work 4. Estimated Cost ..... ..................... .... 0.i~ tm paid on filing this at~l~licationl $. Ir dwelling, number of dwelling units ...... /~. ....... Number of dwelling 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, ir any: Front .., . ...~.~-... ... . Rear . ,... . ..~..3~....... D~pth .. ] .. ~]'] . Height ...... ./.O. ...... Number of Stories .... / .............. Dimensions o£same structure ~vith alterations or additions: Front ................. Rear .......... Depth Height Number of Stories .... 8. Dimensions of entire new construction: Front ............ ... Rear. ...... . . ......Depth .... ... H ig~ N f St ...... e It ............... umber o pries ............. : ................... -. 9. Size oflot' Front . . 7..~' . ..... r~e-,- '-"'' .... '-- :.'' /-~" ........ ~ -- ' ........ -o'~' ~ ' . ~ a ............ ./././. . l~eptn . .w.. .. . . te o~ rurchase . . - '/J~, .... -'~ ' ' ' ~ ~ ' ~-' .... 10 .......... ~a ; r-'~ ~. ............. ~me ofF0, rmer. Ow~,,er ...... ./~.~,,..~.o.r~.~'.//. 1 I. zone or use d~strict in which premises are situated .... A .~._c/.~. ?ft 77~ ./. / '" 12. Does proposed construction violate any zoning law - nance or regulation: 13. Will lot be regraded ..........- .-............. Will excess fill be removed from premize~ , Yes , .. N~.. 14. Name of Owner of premises.. . . . . - . . .. ~ . ddresx Phone No Name of Architect .................... -- ... Address ..... .. . ...........PhoneNo ..... ........... Name of Contractor ' Address Phone No . . ' [5.I.~ thug propert~ located within 3.ao l.eet of a tidal wetland? ~YES .... HO .... :tlf yes, Sourhold Town Truetees Per,alt may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-hack dimensions from property Lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE O F COUNTY OF .... S.S ................ being dnly sworn, deposes and says that he is the applicant 0Xramc o£individual signing contract) above named. ' I-~ is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform Or have perfomed 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 will be pert'ore, ed in the m~ner set forth in the application filed therewith. S,vom to befo~~ ' · ....... ~l)f})~ I~ Suffolk Coomy