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Home My WebLink About21227-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-oN.o 21227Z Permission is hereby granted to: .....¢.~....,....~.....~.~. ............. ...... .......... at prem ses located a . County Tax Map No. 1000 Section .... J...~..~.'~,. ....... Block ...... ..0.......~.. ...... Lot No...!...t'~.'....! .......... pursuant to application dated ....~..~.....~......./....~. ......... , 19.cJ.~l., 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.: 765-1802 \pproved ..-; v~.5.c,.,x.,~ .; : * 19: ;-. Permit No..'.~t ~-"~ i -iL. )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 5OA.~D OF HEALI'II ......... .3 sETS OF PLAN':: .......... SURVg¥ ................... CIIECK .................... SEPTIC FOR:I .............. NOTi FY: CALL ................... HAIL TO: · 50':$J. 032. ,42.... ..... t2 ¥.-- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 ' areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- .tioq. c. The work covered by this application may no~ be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the appl/cant. Such permit · II, 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 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 filding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with al/ applicable laws, ordinances, building code, housing c0d.~e and regulations, and to mit authorized inspectors on premises and in building for necessary inspectiolS'~ r'~--/.~- · . .......... .i./~...:.~..::.~...,:w..;/ ................ -- i (Signaturg,6f applicant, or nar~, if a corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ · ........................................................................... linc of owner of premises· ..~ .3-?.._' .~...~..,~JS/./x/.,~....~.O. './~.'?j ................................. i .......... (as on the tax roll or latest deed) ~pp!icant i~ a corporation, s~gnature of duly autt?rized officer. (Name and title of corporate officer) Builder's License No .......................... PI tuber s Ltcense No ......................... Electrician's License Nb ....................... O/her Trade's License No ...................... Location of land on which proposed work will be done .................................................. .... 3. ............. ........... .................... House Number Street Hamlet Ce.ntT Tax Map No. I000 Section /,3..~'.: .O.~. ......... Block . .~5~. 0.~.~i ........ Lot...~./'./~. 7~../'9/. ....... Subdivision ............ Filed Map No ............... Lot ............... (Name) SIatc existing use and occupancy of premises and intended use and occupancy of proposed construction: ~. Existing use and occupancy .... b Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ~..... ........... Other Work ............. (Description) 4. Estimated Cost ...................................... Fee . .4..~;:.2>;:i'. ............................ (to be paid on filing this application) 5. If dwelling, number Of dwelling units .... .~./Y.,.. ......Number of dwelhng units on each floor ................ · If garage, number of cars ........................................................................ 6. If business ..... commercial or mixed occupancy specify nature.,., and. extent of each type,. ,°fuse ....... "".4'; ~; ....... 7. Dimensions ot exxstmg structures, if any: Front....~.Z.,.Z. ....... Rear ...2.. ~.,.~. ...... Depth .?. ............ Height ............... Number of Stories .... Q. ty.~. ............................................... 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 ............................................ i: .......... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase . .. ~.~.~..7'.../.ff.~-.~ .... · ......... Name of Former Owner .B/~.?././~.W...~..°~.~.~.4~.~.~ ........... 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate -~ny zoning law, ordinance or regulation: ................. · ............... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Nme 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, and. indicate all set-back dimensions fromm property tines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer 16t. ~ rATE OF NEW,AZORK/'/" /]-/ S S · · .' . ~ ['~( i/?~ ~ ~C.~5 f-¢ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ore named. · (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly authorized to perform or have performed the said work ~nd to m~e and file this ~lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be pcrfo~ed in the manner set forth in the upplication filed therewith. om to before me thi~. .......... ~mi~ion Expires December