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Home My WebLink About20338-ZTOY/N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER'AlT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*_ 20338 Z Permission is hereby granted to: ....... ~...~,.....~ ............... ..... ~.....~.~ ......................... ~ .............. ...~~~-....~.:~., ...... ZZ..t...~.~-..... . at premises located at .....~.?...~..~..~ .......... .~.~........~... ............... ~..~.~.~, ................ County Tax Map No. 1000 Section / ~ 3_ Block C~ ~ Lot No. pursuant to application dated~~....~... ........ .~...'~ ............ , 19..~..J.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-t 802 ~"a'nined..~-'-~. ).'t, 19 .~.1. ..\ppro,';d~.. I .'Tr., 19 .qJ. Permit No. A.O'..~.. {~.."~- Disapproved a/c ..................................... ................. . ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTiI ......... 3 SEToe OF PLANS ......... SURVEY ...... c , l E c ~ . '/z'~,'dSC. Z ; . :.::; SEPTIC FOR:I .............. CALL l'lg iL TO: Date ', .., 19... INSTRUCTIO NS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by tkis 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 hall 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 sail have been granted by the Building Inspector. APPLICATION IS HEREBY blADE 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 ,egulations. for the construction of buildings, additions or alterations, or foe removal or demolition, as herein described. he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to Jmit authorized inspectors on premises and in building for necessary inspections. .~ ex ~, f') ..... ........... · (~ttature of applicant, or n~qnke~ ~"-q corporation).., .... (Mailin= address of applicant) /]~ ~""'~' tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. lame of owner of premises .......................................................................... (as on the tap< roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ~uildor's License ~o. 0r0'/./s iBnc, S g/o6, Plumber's License No ........ : ................ Electrician's License No ....................... Olber Trade's License No ...................... Location of land on which proposed work ~vill be done .................................................. ...... ....... llouse Number Street Hamlqt Co,.,,~.r~,~lap~o. ~000Soc,ion .f.¢...% ....... n,oek¢. Lot 2..~.. · Subdivision ..................................... Fired Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ',,stinguseandocc,pancy .... .... ........ : ...... : ..... , .... b. Intended use and occupancy ... 3. Nature of work (check which applicable)/( New Building .......... Addition .......... /alteration ........ Repair ............. Removal ...'~ ...... Demol tion ........ Other Work · (Descr/ption) 4. Estimated Cost.. Fee ~'../.'-.'ff.' '~''- (to be paid on filing this application) $. 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 nurture 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 ...................... ttcight ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Fi'out ...................... Rear ...................... Depth .. ..................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district itl 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 ................ of Contractor Address Phone No ' Nam e ............................................................. 15. Is this proparty within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town 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 inter/or or comer lot. 8~ COMPLETE FOR CO THE REQ¢IREMENTS OF THE NY STATE CONSTRUCTION & ENERGY COD~S, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF ou,vrv .. ' ..... ?~_..5..Ct .k~%.e._~. [ .'5....~L'~. .......... being (Name of individual signing-- ~ '~conrract) )eve hauled. duly sxvorn, deposes and says that he is tile applicant is thc ......................................................................................... (Coutractor, agent, corporate officer, etc.) said owner or owners, and is duly author/zed to perform or have perfonned the said work and to make and file this plication: /bat all statements contained in this application arc true to thc best of his knowledge and belief; and that the ,rk will be pcrfo~ed in the m~ncr set forth in the application filed therewith. om to before mc this . ~u~ Dual,lied 'r ,efta ~ CounN ~T/ , , '~i~ o; a;phcant) ~mmi~ion E~ires December 8, I[F~ {~