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Home My WebLink About21958-ZFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HA~ $OUTHOLD, N.Y, N~ ~1958 ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} Permission Is hereby granted..k):~ ,/ __. . / ,~,~.~?~~./.,. .............. .,,.~z..9.~. ......... ........ ~i'~i~,i~i'i~',~'~ii'.i ~..'~i i.~i .'.'~~ii...". '.'i i~i'.iiiiii'.iiiiiiii'.ii'.ii i'.'.'.'.'.'.i1711 '.'.'. couo~,Jo× Mop No, 1000 Seot~o, ..,,.~..~ ........... B~ook ........ ~ ............ Lot ~o...~ ................ pursuam ~o application dated ... Building Insp~lor, ................ Rev, 6/30/80 ................ CIIECK ................. SEPTIC ¥ 0 R,"l ........... FORM NO. 1 ~%~,~~I! TOWN OF SOUTHOLD I BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~.,/~[ .,~.~ TEL.:765-1802 t:OTIFY= CALL ................ ;xan~i~,eh~'-o~.~O[h'~OLp~ .. 9., : .' . , . ~ . ~/": ~0 ~,~ ~~ , (Buildin~p~r) . ....... INSTRH~IONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit~ sets of plans, accurate plot plan to scale, Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relation~ip to adjoining premises or public sti'e or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt cation. ¢. The work covered by tiffs 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 pe~ 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 Occup~n 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~nd other applicable Laws, Ord._aa_ceos · , ~'t'a~tkm 'of buildingS,' additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary i~ctions. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee,'agent, architect, engineer, general contractor, electrician, plumber or builde: Name of owner of premises .................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) uilder's License No ....... Plumber's Lice:~s¢ No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ltouse Number Street ' ' H~hmlet Block Lo, 7. 3 -.3./. Subdivision Filed Map No. Lot ...... : ..... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ..................... ' ......................... ....................... · '3. Nature of work (check which applicable): New Building .......... Additio~ .... ~ ~i~ -~{~" ....... ' Repair Removal ......... Demolitio.n... : ......... O~~ ....... 4. Estimated Cost ................ Fee ................................ (to be pa c~ q.n_.fiHnt: this 0gplication) $. If dwelling, number of dwelling units... ........ . Number of dwelling units on ei~}~7$~i~ ............ .If garage, number of cars .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of.each type of use ................... 7. Dimensions of existing structures, if any; Front ............... Rear .............. Depth ............ Height ............... Num bar o f Stories ..................................................... Dimensions of shine 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 ..................................................... 2. Size of:o£: Front ......... , ......... 2.. Rear ...................... Depth .................... I0. Date of Purchase .................... · ......... Name of Former Owner ........................... 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 frompr~ises:. . Yes (.~ 14. Nam .......... ~ ............................................................... Name of Architect ........................... Address ................... Phone No ............... Name of Contractor ....................... Address ................... Pho;~e/4'o ............... 15. Is this property within 300 feet 'of' a tidal wetland? *Yes ........ No..~ ..... · If yea, 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. :OUNTY OF .... .-of.c3.. .... ~.~, [~,..f~ .,. ,~.. ,~.. (..h~. ,~, ?.,, being duly sworn, depo,e, and says that he is the applicant (Name of individual signing contract) bore named. is the (Co;tract~rpoiate officei,'elc ' .) said owner or owners, and is duly authorized to perform or have performed the said work and to, make and file this ]plication: that all statements contained /n this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. gore to before me thiW F...C,/~. '.~ // 19, ........ . . .......... NO. ~79505 ~ t , - Qualifl~ ~mi~ion