The URL can be used to link to this page

Home My WebLink About22393-ZF~RM NG.$ TOWN OF $OUTHOLD BUILDING DEPAJ~TMENT TOWN ~ SOUTHOLD, N.Y. 22393 BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNT1L FULL COMPLE11ON OF THE WORK AUTHORIZED) Date ,. ,..:f.~./~;~,. ,~,, .................................... 19 .~.../~...., Z at premises located at.....~ ..... ~ .............................................................................................. CountyTaxMap No. 1000 Section .......... ~ ........... Block ............... ....~....... Lot NO ........ ~'i / ........ pursuant to application dated ........'~_../(~.. ~ ................................... 19.~...~... ..... Building Inspector, and approved by the Rev. 6/30/80 ~;t)(: ~3 !'7 TEL.: 765-1802 Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOAKD OF IIEAL'rll ......... SETS OF PLA~{S .......... SURVEY ................... CIIECK .................... SEPTIC FOR,~I .............. t:OT I I=Y: CALL ................... {'IA [ L TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 et: or 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 ~r areas, and giving a detailed description or layout of property must be drawn on the diagram which is part'of this appli- :ation. c. 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 hall 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 aCertificate of Occupancy hail have been granted by the Building Inspector. APPLICATION IS tIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ]uildlng Zone Ordinance of tile Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~,egulations, for tile construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['lie applicant agrees to comply with all applicable laws, ordinances,, building code, housing code, and regulations, and to ;dmit anthorized inspectors on premises and in building for necessary inspections. ...... .2y..x ............. (Signature of applicant, or name, if a corporation) (Mailiug address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... .~q ......... .e'.~ ........................... ...................... (,as oll the t,m< roll or latest deed) if applicant is a corpor~tiou, signature of duly authorized officer. (l~dme and title Of cor~porate officer) Builder's License No .... ./~ .'7..~.~.~....."~..'.'.~.' ...... Plumber's License No. °~-'5-'~~'' f'~ Electrician's License No. ~'°)t'/'~ ~ Other'Trade's License No... ??.~?.7.../??.' ....... Location of laud on which proposed work will be done..' ................................................ Ilouse Nmuber Street tlamlet · / Couuty Tax Map No. 1000 Section ~' Block oP Lot .~v.* Subdivision ...................................... Filed Map N0::::e ..~. t ........ Lot ............... (Name) State existing use and occnpancy of premises and iutended us~ and occupancy of proposed coastrui:tion: a. Existing use and occupancy .............................................................. b. Intended use and occupancy ....................................... ' ................. 3. Nnllmre o£work (check which apldiC:tble): New IhHhli.g .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .~ ........... Other Work ............... ~:~ (Descdption) 4. Estimated Cost ................................ ee ................................ (to he paid on fili~g this 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ . If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify uature and extent of each type of use ..................... ~. Dimensions of existing st~ctures, if any: Front ............... Rear .............. Depth ............... lleight ........ Z ...... Number of Sto~e$ ........................................................ Dimensions of same stmctnre with allerations or addi~ion~: Front ................. Rear .................. Depth ...................... ltei~ht ...................... Nmnber or Slories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Sto~S ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ~. ..................... I0. Date of Purchase .......... i .................. Name of Former Ow.er ............................. I I. Zone or us~ district in which premises ar~ situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~ ............................ 13. Will lot be regraded ............................ Will excess flu be removed from premises: Yes No ~4. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ......... ....... 5. Is this property within 300 feet of a tidal wetland? *Yes ........ No...~ ..... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGI~M ... Locate clearly ~nd distinctly'~l buildings, whelher existing or proposed, and. ~ndlcate all sebbsck dlm~n~ion~ from woperty lines. G~v~ street and block number or d~scdpfion according to deed, and show ~tr~et n~e$ and indicate whether ute~or or corner CONSTRUCTION SHALL ¢~IE~ CONSTRUCTION & ENER{~Y ~OT RESPONSIBLE FOR DES¢G~ O~ CONSTRUCTION ERRORS 'ATE OF NEW '~ttK... s.s .............. ~...~....................~'/~ being duly sworn, deposes and says that he is the applicant (Name of indivMnal signing contract) ore ~mcd.' is the ......................................................................................... (Co, tractor, agent, corporate officer, etc.) said owner 0r owners, and is duly authorized to perform or have perfommd the said work anti to make and file this )lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rE will he performed in the ~n~ner set forth in tim application filed therewith. om to before m~ds ~ T~m Expires