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Home My WebLink About20453-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N~ 20453 Z .... ~.~? .......................... ., ......... ~ _, ..-~ '~-- __ ........ ~,..~.,.~,..~..,..z~.~.z ........ ' ,o ........ ..... at premises located .......................................................................................................... County Tax Nra, No. 1000 ~ection ........ .~..~.... ..... Block .......... ~ ....... Lot No ......~.. ............. ~,u,.uo,,, ,o o,,,,,,.a,,on dot.,, ............ ~Z.. ............................ . ,~9.l... o,,d op,,,o,,..,, ,., t,,. Building Inspector. Fee $ .......... Rev. 6130/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTll ......... 3 SETS OF PLA~tS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. 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 o£ layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this application may not be c~mmenced 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 paxt for any purpose whatever until a Certificate of Occupancy hall 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 ;uilding Zone Ordinance of the Town of Southold, Suffolk County, Ney~'ork, and other applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alterations,/or 1 pr removal o$.~lition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, bt/ildi! ~g code, hgu'sing cfltde, and regulations, and to dmit auth°r/zed inspect°rs °n premises and in building f°r necessary in~.., c.~ [°n°.? ' .3Vl~., .~.. ~..~.~. '~i (Signatu[e of applicant, or name, if a corporation) ........ (Mailing address of applicant) applicant (owner,~see, agent, architect, engineer, general contractor, electrician, plumber or builder. ;rate whether qame of owner of premises .~~. ~.'.. ~ .-.T .~-:.L....~.. .......................................... (as on the tw_x roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Locationoflandonwhichproposedworkwillbedone.~~.t..~..~7.(__ ................... · ......... .................... ; IIouse Number Street County Tax Map No. 1000 Section / ~: Block ~:> (CD .................................... Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ... (.; ~; .... .. ,~ ........... ......· 4. Estimated Cost .,]z~ 9. '~ 5. If dwelling, number of dwelling units Nature of work (check which applicable): New BuiMing .......... Addition .......... Alteration .......... RepaSr .............. Removal .............. Demolition ,~- Other Work ............... (Description) (to be paid on fiIing this application) If garage, number of cars ............... Number of dwelling units on each floor 6. If business, Ommercial 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 ..................... Depth -~ ~,,. ,, . · .... Rear ...... %~' t.' .......... P/el ~llt . . . .................. 8. D:mensions of h~ ,. .... g ................. Number of Stones . . . r. · e t--~,::-r, ~u.strtlCtlon: Front ..... R ............. ~e~ght ............ !~.. Number of Stories .......... ear ............... Depth ............... 11. · · '' n 12. ! . 13. rd ............... iiiiiiiiii 14. Name or' Owner of premises ........... Will excess fill be removed from premises: Yes No .................... Address Ph Name of Architect ................... one No ................ ........................... Address Name of Contractor ................... Phone No ................ ~5. Is this .......................... Address ................... Phone No ................ property within 300 feet of a tidal wetland? ~Yes ........ No ......... · if yes, Southold Town Trustees Permit may be required. -. PLOT DIAG P~4_M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property l/nes. Give street and block number or descriptioi~ accord/ng to deed, and' show street names and indicate whether interior or comer lot. AP, PRO, VED AS NOTED 3. INSULATION 4. FINAL CONSTRUCTION MUST EIE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCllON & ENERGY CODES. NOt' RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK, · . . ' ' '.' . .................. being duly sworn, deposes and says that he is the applicant 'e is the (Contractor agent corporate officer ........................... , , , etc.) £ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork w//l be performed in tt~e manner set forth in the application filed therewith. *orn to before me this .............. ~ ..... day of ...... 7.~ ..... ,19 .~.Q . ~. ~22~, S~ ~ ....... . .... Te~ ~i~ Ju~ 1~ I~3 (Signature of applicant)