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Home My WebLink About20995-Z · IvO~,M NO. · TOWN OF SO~TNOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_N? 20995 Z Permission is hereby granted to: ..~.~...£~.....~.~ ...~-~..~.~.-..~-~...~~ , .~.~~~..~...~..~~ ' ~,~,~,,~,.~, ....... ~..~.~..~.....~.~...~~ ........................... ............................................ ..................................... ~ ~x ~ ~. ,ooo ~,,o~ ...~.~...~ ..... ~ ...... ~ ........... ~, ~ ....... h~ .......... ~n, ,~ ~,,~,io~ ~,~ ................ ~ ........ ~ ...... ,~.V~ ~ ~ Building Inspector. Rev. 6~30~80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined ................ , 19..'. Approved ~'~....~ ....... 19?&Permit No...~. ~..t~..~.,~" ,~ Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. 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 any 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary igspections. ~' · g....C.: ............... -- (Signature of applicant, or name, if a corporation) / (Mailing address of applican~ ) ~ X~'- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~..0.t."~...~.~.-/...~..l~..]~. it.. C-..~. ........................................... (as on the tax roll or latest deed) Builder's License No .... ~..: Plumber's License No ......................... EIectriqian's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work willbe'done. ......... ·- ........... ............... House NumberStreet ..... · /O-..~. ..... Block ..... ~ ........... Lot .... ~ ........... County Tax Map No. 1000 Section Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and . intended use and occupancy of proposed construction: a. Existing use and occupancy . . .~. . ~ .... b. lntended use and occupancy .... ~' .7 .~ffe~ ~ 3. Nature of work (check which applicable): New Building .... ' .....: .AddiSon .......... Alteration .......... Repair .............. Removal .............. Demolition .~c. ........... Other Work ............... ~' (Description) 4. Estimated Cost ..... /.ff.~.t~...~. ........................ Fee..~..I.~.~ .~'..?. ......................... (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 busine~ss, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ?~-_Dim'emq/e~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 Former Owner ............................. 1 1. 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 ............................ Wilt excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property 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, a~.d. 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. STATE OF NEW YOlk, ~ ,. ° S ' °' ,) .... ~ ~,. ~.~ ~ ~ .~ ~ ............. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the ............................. r, ~;nt, ~orporate officer, etc.) of said owner or owners, ~d is duly authorized to perfom or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the ~h~-~¢t forth in the application filed therewith. Sworn to before me this ..................... Zf ~~.~, ¢~ ......... }Signature o f applicant )