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Home My WebLink About21681-ZFO~'M NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAiL $OUTHOLD, N.Y. 21681 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLETION OF THE WORK AUTHORIZED) CountyTax Map No. 1000 Section ....... ~ .......... Block .......... ./.. ............ Lot No.....'~.... .................... pursuant to application dated ....~ / ~. .......................................... 1 9,,. ~-~. .... / Building Inspector. and approved by the Rev, 6/30/80 t~--- ~ ./~.~ .~ . ~, ~ FORMNO. 1 3 SETS OF UILDING DEPARTMENT CII~CK . ~ .... ~ ~/~ t TOWN HALL SEPTIC FORH .............. SOUTHOLD, N- -Y 11971 TEL.:765'1803~/ ~,O~' ~'~FY; __~ . - ~ . .7~J:.~.~ ....... ................... Approved ........ , 1 Pe it No. . Disappr0ved~ a/c ' ' ~ l~- I, (B~lding I~ector) ~ INSTRUCTIONS a. T~s application must be completely filled in by ~pewfiter or in ink and submitted to the Bulldog Inspector, with 3 sets of plans, accurate plot plan to scale· Fee according to schedule. b. Plot pl~ show~g location of lot and of build~gs on premises, relationship to adjoining premises or pubic streets or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this app,- cation. c. The work covered by t~s application may not be commenced before issuance of BuQding Pemit. d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pemit to the appQcant. Such pemit sh~l be kept on the premises available for ~spection throughout the work· e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by ~e Building Inspector· APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for thc issuance of a B~lding Pemit pumuant to the Building Zone Ordnance of thc Town of Southold, .Suffolk County, New York, ~d other appUcable ~ws, Ord~ces or Regulations, for ~e construction of bufld~gs, additions or alterations, or for removal or demolition, as here~ desc~bed. The appQcant agrees to comply with all appQcable laws, ordinances, bufld~g code, housing code, and regulations, and to admit authohzed ~spectO~ on premises and ~ build~g for necessa~ inspect~z ~ (Sign~ure~f applicant ~ ~ if a corporation) (Mailing address of applicant) State whether applic~t is owner, lessee, agent, architect, en~neer, generai contractor, electrician, plumber or builder. ............ ~.~. ~%~- . ...................................... Nme of owner of premises ........ ~. · ~ ~ ~ ~..G ~.~* 3~. ............... (as on the tax roll or latest deed) If 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 ...................... Location of land on which proposed work will be done ................... · ,¢~..;~. ·, .~.. ,. ,zv~..~ .~t ,r<.~A ~. ' . c~ ~.~ .,.~.o..~: ......... llouse Number Street Hamlet County Tax Map No. 1000 Section .... '..~..~. ........ Block ..... . .~....]..i... Lot ..... .~ ............ Subdivision · Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy ofproposed construction: a. Existing use and occupancy ... .................................................................. .. ......... . ...% .£.~. .~J.¢.~-. .......................... · 3.Nature of work (check which applicable): New Building .......... Addition .......... Alteration .'...,... ].. Repair Removal ........ Demolition .................................. Other Work ............... .... (Description) 4. Estimated Cost .... ,~.~'c.~O ....... ; ........................ Fee ...................................... (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 business, commercial or mi)~ed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... .2-,.q-~. ....... Rear ...~(3 ....... Depth ...2~2~. ........ Height ..... ~. '. ....... Number of Stories ....... I ................................................. Dimensions of same structure with alterations or additions: Front ........ ~ ....... Rear .. ~. .............. Depth .... . .......1~ .......... Height ...... C2.,: ........... Number of Stories .... (~. ..... ; .......... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ....................... , .................... ' ............ 9. Size of lot: Front ......... , ......... ... Rear ...................... Depth ...................... 10. Date of Purchase .................... ......... Name of Former Owner ........... t~' ! '" "' ' ': ....... 11. 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 ....... : .................... Will 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 ..... No.... 15. Is this property within 300 feet of a tidal wetland? '*'Y'e's'.'~..'.'.'.' ·PhOneNo ....... .............. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give s~reet and block number or description according to deed, and show street names and indicate whether interior or corner lot. COUNTy OF ..... ~....~C... S.S ....... .......... (Name of individual signing contract) above named. r55, I802 9 AM ~ 4 PM FOR THE ~C,R POt ~RED CONCRET~ COa~P~ al'~ FOR C.O CONSTRUCTION SHALL MEET REOUIREMEN~ OF THE NY ~;~E CONSTRUCTION ~ ENERGY COPES. NOT RESPONSIBLE FOR ¢FSa~N OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant He is the ..... . ...................................................................... . .............. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application: that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the maflm~,r set forth in the application filed therewith. ' Sworn to before me this ......... [ ...... of. ...... 1973 otary Public · · · .~--¢'-,//,~.., .~4~.¥-~..;ff;4~.-~l;~:~fa>Z/': ;' ,- County . !~. 4725089,..'~m_K ~,.'~3~// ' '