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Home My WebLink About19838-Z I~OB~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ~HIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORI?ED) 9838 Z Permission is hereby granted to: ~7~.. .......... ~~.....~....~./....~. .... .... ~,. ...... .~....~.....~...~.~ ................ ~ ...... ~....~~ .................. ~~.~ ............................................ atDmmi,s '~at~ ~ ...~~......~~.,...~ ...................................................... .~ .............. ;~ ....... ~.~.~...~.~, ......... :~ ..~ ........ ~ ...~..~...~.~.. ~..~~..~~ .... ~/~/ ~n~ Tax Map No. 1000 ~¢tion ........ ~.~..~.., Bl~k ....... ~ ......... ~ No ...... ,~ ........... pu~uont to application dm~ ........ ~ ................................. ~9~., and appr~ ~ ~e Building Insp~tor. Rev. 6/30/80 ~xamincd FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 )isapproved a/c ..................................... INSTRUCTIONS BOAKD 0F HEALTII ......... 3 SF__TS OF PL,%NS .......... SURVEY ................... CIlECK .................... SEPTIC p 0 R,'I .............. NOTI FY: CALL ................... FLAIL TO: a. This application must be completely filled in by Wpewr/ter or in ink and submitted to the Building Inspector, with 3 ts 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 : areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- trion. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit :all 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 any purpose whatever until a Certificate of Occupancy all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~. rsuant to the 41ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and.~t'h~' a-i~ptic~ij~i%"T~3.ws~Qrdinances or for the construction of buildings, additions or alterations, or f~-de~_3~t~>rr,~,~.. ~/ ~-- ~--~/ . . described. 2gulations, le applicant agrees to comply with all applicable laws, ordinances, b~kl~l~;~ ~~gulations, and to imit author/zed inspectors on premises and in building for necessar~d'~s~ zo~/~//// //~ _ ate whether applican~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~me of owner of premises L . .(3. [ .,, 1. ~'~.~ .... ?. ~ .......... (as on the raj roll or latest deed) applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No..~.i"~ .~.O..~. .?.~..l~.O~.....C-.~. ?4F_F~I~/"~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which prop,.os~d work will be done. 827 ;L¢ .... 33 .... ........ i House Number Street Hamlet County Tax Map No. I000 Section . , .'/.~. ~ ...... Block '-~ Lot... /~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of prcm~s and intended use an~cy of proposed construction: a. Existing use and occupancy ....... .~(~.,-~'~ 1 .~'~ .... :~...~.t.~..C~ .I. ~ ~lj~J~_r?j,!~k~,..._2~~ .... b. Intended use and occupancy ........................................... ~,a:).,, ~;',,.'-'~ I~t{l~,~.. ,,t · · 3. Nature of work (check which applicable): New Building ......... .. A~'. ....... Alteration ....... :. Repair .............. Removal .............. Demolition ~.. ........... Other Work .............. ~ :¢ ~e~ ~ (Description) 4. Estimated Cost ...................................... Fee ..... ~; (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of 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. Sizeoflot: Front ...................... Rear ..... ; ................ Depth ...................... 10. Date of Purchase ............................. Name of For,net 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: '/es No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ '-5. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAG RAM Locate clearly and distinctly all buildings, whether e. xisting 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 corner lot. FATE OF NF~F~F~F~F~F~F~F~F~F~/YO~'~/~,, (Name of individual signing codtract) ~ . ore named. is the ......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly authorized to perform or have perfo~ncd thc said work and to m~e and file this ~lication; that ali statements contained in this application are true to the best ofhls knowl~nd belief; and that thc rk will be pcrfo~cd in the m~ner set forth in the application filed therewith. om to before me this ............