The URL can be used to link to this page

Home My WebLink About20579-Z I~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/v~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: /..~..~....~..,...L..7.~...~..~7~..Z.~.~.£~., .... .~.~.....~-~.~...~....~..../..~.~.~.~. ..... . .... ' ~ . .. ~,/// ~ ,// / . ' ......... i"~/~'~"-~ ....... '/~/~-'~':'~%'"":"'"~"~"~'"~' ................................................. ......... .............. Co~n~ Tax Mop No. '000 $,c,ion ....... ..q.. ............ B'~k ...... 3. ........... Lot No ..... ~. ............... pursuc~n, to application doted .......... ~ ........ ..~. .......... , 19..~..~,~ and approved by the Building Inspector. Building In.q~ctor Rev. 6/30/80 ~ TOWN C,F :5 ~.:~ ...... ~ Exan~in~d................. [9... Disapproved ale ..................................... FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTItOLD, N.Y. 11971 TEL.: 705-1802 BOARD OF HEALTH ............ 3 sETS OF PLANS ............ SURVEY ..................... CIIECK ...................... SEPTIC FORH ................ NOTIFY~ CALL ..................... HAlL TO: (Building Inspector) APPLICATION FOR 131JILDING PERMIT Date ................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Buildin=JiaSPector, with 3 sets of plans, accurate plot plan to scale. Fcc according to schedule. b. Plot pl;m showing location of lot and of buildings on premises, relationship to adjoining prcmlS~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which i~lr:J~ of th.is appli- cation. 11. The work covered by this application may not be commcnced before issuance or, Building Permit. d. Upon approval of this application, the Building Inspector ~vfll issued a Building Permit to the appli~nt. 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 a.ny purpose whatever until a Certiflc:al~__ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issua, r~'~ of a Building Permit im~uant to the Building, Zone Ordinance of the Town of Southold, Suffolk County, New ¥oYk,/and] other applicable/..a,~. Ordinances or Regulations, for the construction of buildings, ad~ditions or alterations, or for re~v~l or .~/l~olition, ~s ~ described. The applicant agrees to comply with all applicable laws, ordin~n, ces, buildin~ co~t~, ~ousina ~ode, and rcg-,~tions, and to admit authorized insvector~ on premises and in building for neceosary inspcctions~ll. (..OMv'/~. ~ (Signature of applicant, or name. if a corpom;mn) ga. .da:. 2.9. :., ...... '. · . (Mailing address of applie2a~t) Stale wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name owner o.},rem,sese-; .......... (as on thc tax roll or iarest deed) If applicant is a corporation, signature of duly authorized officer. t/tie o 'dogd;ate 'o' ficgr) ........ Builder's Licemc No Plumbcr's License No Electric;an s lJccnsc No · . Oilier Tradc's License No 1. Location of land on wliich proposed work will be done; · ' House Number Strec~ Hamlet Subdivision ~ [ ~' 0 El]~d Mup No. . ......... Lo~ .[~. ~ / ~ "~ (Nm.c) · State uxisl{n= u~ end occupunc7 oF prcmJsc[ 3nd inlcndcd usc end occnp3ncy oF proposed conslruci{o~ 3. Nature of work (check which applicable): New Buildi~.. Addition .......... /dteratmn .......... Re :ur .... Rt~movai .............. .F.~..e,'~t su/.mmng poor ........... .... :: .. acces r ........... ..... o y gu~auang ..... ; .... Fence ....... Other [4ork ............ 4. ~timated Coat . . ' ............. Fee ....... : O Oo be paid on filing thi~ a0plication) ......... ......... :: ...... If garage, number of carx ................ ~ ............................................ 6. If bu,inca~, commercial or mixed occupancy, apccify nature and extent of each type of u~e .................... 7. Dimcnaionaofexiatingatmcturc~,ifany: Front .... ~ ....... Rear .~.~ .......... Depth... ....... . ... Height .1~ ........... NumbcrofStohca.[ ..................................................... Dimensiona of tame structure witb alterationa or additiona: Front ................. Rear .............. .. Depth ...................... HeiSt ...................... Number of Stones ..................... 8. Dimcnaiona of entire new conatmction: Front ............... Rear ............... Depth .............. Hcigl~t ............... Number of Stohe~ .............. ; ........................................ 9. Size of lot: Front ...................... Rear ...................... Depth ..................... 10. Date of Purchase ............................. Name of Fomcr Owner ............................ 11. Zone or use district in which premises are ~ituated .................................................... 12. Does proposed constructlon violate any zoning law, ordinance or regulation: ................................. 13. W~I lot be regraded .; .......................... Will exce:~ fill be removed from premiae*: Yea .... No 14. N~e of Owner of premise, ~.~*.*~. Addreasl~.*;~P~[. Phone No ~j~.'9.~[~. Nme of Architect .~.~.~ ......... N~e of Contractor . ~)~..~.. i ........ Address ~*. 15~Q~ .... Phon~No. 'c ' '~'' 15.Ia thla property located ~ithin ~If yes, Southoid Town Iruagees Permit may be required. PLOT DIAG~M Locate cle~ly ~d diat~ctly ~I bu~d~g~, whether existing or proposed, ~d. indicate ~I tot-back d~*n~iona from prope~y ~ne~. Give ~treet ~d block number or deacfiption acCord~g to deed, ~d ~how street n~ea and ~dicate whether mtehor or comer lot. gTATE OF NEW YORK.,.,,, ~ S ..... ~-X-~.q-x'- · -'.cr~ .............................. being dnly sworn, deposes and says that he is thc applicant {Namc of individual signing contract) :bovc named. ~ is the ' (Contractor, allent, corporate officer, etc.) ~f said owner or owners. ~d is duly authorized to pc,rform or have perfo~cd 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 york will bc pcrfomled in tile m~ner act forth in thc application qlud.there~ ;worn to before mc this ~ ~ [~.'.. oza~ Pub (Signature of applicant)