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Home My WebLink About21069-ZTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_N.° 2106~Z Permission is hereb¥~aranted to: ,~ /' /2.. ,~ ..~.. ,~ ~ . //.~ ...~~.. ~ ..~~ ........ ,. ...~ ....... ~~-~..:-~ .............. ~.:..-~ ............................................. ~ ,re, i,, ~o~,d ~ ..~.~...:.~..~~....~ ............................... ................................................. ........................................................................... Coun~ *ox gop ~o. 1000 S~ctlon ...... ~Z..~ ....... 81~k ......... ~ ........ tot Uo...~ ............ pumu~nt ~o opplic~tion dot~ ........ ~.~ .......................... , 19~ ~nd oppr~ b~ ~ Buildln~ In*p~ctor. R~v. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 \pproved . . ././~. ......... 19~- .c~. Permit No .......... APPLICATION FOR BUILDING PEFIMIT INSTRUCTIO NS a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ts of. plans, accurate plot plan to scale. Fee according to schedule. b. iPlot 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- e. 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 aJl be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pazt 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 Permit pursuant to the :tiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or :gulations, for the constr~ction of buildings, additions or alterations, or for removal or demolition, as herein described. :e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in,,building for necessary i~ctions. -- .- ~. ',. · (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder2 me of owner of premises . . - · (as on the tjx roll or latest deed) ~pplicant is a corporation, signature of duly authorized officer. title of corporate officer Builder's License No ~ lumber s L ccnsc No ......................... Electrician's License No "- Other Trade s Licen e No Lo atio cfi d hi hp d k ilIb d ' c n an cnw c ropose wot w e one ......................................... ... ........ louse Nu,nber Street Hamlet, ,' V, /,i ~ ~?:'.... :otmty Wax Map No. lOOOSection ...Z~ .......... Block ............ ',[,.'Lot.;..~.~ ......... ubdivision . . (Name) Filed Map No ...... ~ Lot . . x':- · < ......... tale existing Use and occupancy of premises and intended use and occupancy of proposed congtruc.t~on: -Intended usc and occupancy ~~- 3. Nature of work (check which applicable): New Building . ;,;~ .... Addition~,-~ ......... ?teratmn ..... Rcp r .............. Removal .............. .... .... , ......... (to be paid on ~]ing this application) 5. If dwelling, number of dwelling units ...~ ....... Number of dwelling malts on each ~oor .... :5 '. ......... . If garage, number of cars 6. If business, commercial or mixed occnpancy, specify natur~ and~xtcnt of each Iype of use . ~ ............... 7. ~imcnsio~s ~e~sgn~s[~cturcs, fa,y: Front. ~ '~" Rear .~O t_~,t a .,. ~t.~ h Hc,'ht ~ -~ ~ -~ -, , '''~ ....... -'.:l ....... ~,. ~cpta .~.g, .~. o ........... ~...mUmbcrofStorms ., ~ · D~cnmons ofsame structure wit t altcrat ons or additions· Front ~ t_~& ...... ~ ...... ~' ;_' · ~ ......... ' ' · .................. ear ~ Depth..~.~.~J'... He , , ~ ~Xt-~~ ................ ;...; ......... NumbergfSt~nes ...~ 8. Dimensionsofentirenewconstmcfion:Front.~.n~ .... ]. Rear...~.:~Y...~D~pth ~- ~h[.... X... ~..: .< ~.,n b~ or stod~... 2 .* .~~ . 9. ~izeot or Front ~./~* ~ ' ~ z~¢")~v ................. ~ .... , ...... ' ''' ~- -~ ........... ~ear ...... ~ .... .'.C ~0' ~. ~ -- .................. . Y?Y. .......... ll. Zone or use district in which premises are situated ..... ~, ~.~ ........... .......................... 12. Does proposed construction violate any zoning law, ordinance or reguJatiom . ~ ....................... 13. W~I lot be regradcd .... ~ ............... Will excess filI be removed from premis~: Yes .............. ~ · ~. , . ~ ............. rllo~e INo~. ~.~. N~e of Contractor ..... ~ .................... Address ................... Phone No .... .5. Is this property ~ithin 300 ~eet of a tidal ~etZand? *Yes...~ No ...... ' ........ ;'' · If yes, Southold Towa Trustees Permit may be ~equired. ....- PLOT DIAG ~[ Locate clearly and distinctly MI buildings, whether exist~g or proposed, and indicate ~1 set-back d~ensions from >rope~y Hnes. G~ve s,feet ~d block number or description accord~g to deed, and show street nines and ~dicate whether nte~or or comer lot. APP/RO)/Eil AS NOTEO THE R~QUIREMENT~ OF STAT~ CONSTRUCTION & COOES, NOT R~SPONSI6LE FOR DESIG~ OR CONS~U~ION ERRORS ATE OF NEW YORK, .............. ~'~ ........ ¢ ........ being duly sworn, deposes and says that ho is the applicant (Name of individual signing contract) ye named· s the .............. (C ) ......... ontractor, agent, corporate officer, etc. aid owncr or owners, and ia':duly authorized to perform or bare performed thc said work and to make and file this ication; that all St.lteJncnt~ c'otl'.llincd in this application arc true to thc best of bis knowledge and belief;and that tile '-; '.viii bc pcrformcd i,~\thc man~cr sCt?orth iu thc application filed therewith. m to before~nc this '/,, , , ,,-