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Home My WebLink About24203-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.° 24203 Z Dote ............................................... 19. Permission is hereby granted to:~ , .. .~...~....~ .................................... ~o..~..~....~.../~ ....... ~ ...... ~....~.~.J~.~......~~ .... .~.~ ........... ~../~ ........... ~ ........ /~...~........~.,......~. ............ c~,~, Ta,, Map ~o. ,000 Sec,ion ..... ~..~ ......... "'o~ ..... ~..~.. ........ Lo, ~o..../.~-..~. ...... pursuant ,o application dated ......... ..../~..~'~......~...~... .......... , 19..~.1 and approved by the Building Inspector. / Rev. 6/30/80 FORM NO. 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.! 765-1803 Examined ...... ~'~.~.~,....~ Approved ......... , I ermit No. Disapproved a/c ..................................... APPLICATION FOR'BUILDING PERMIT INSTRUCTIONS ' 3 SETS OF PLANS .......... .!. SUP, VEY. , .... , ....... ' CilECK ............. SEPTIC FOlt fl .............. IlO? 1 P¥ J CALL .......... , ........ H^IL TO: a. 'I'lds application must be completely filled in by typewriter or lu ink and submitted to the Building Inspector, with 3 sel~ of plaos, accurate plot plan to scale. Fee.according to schedule. b. Plot plan slowing location of lot and of buildings on premises, relationship to adjoining pre~nises or public streets or areas, and giv~g a detailed descriptiou of layout of property must be drawn ou the diagram which la part of this appli- catiou. c. The work covered by thJ~ application may not be cmmnenced before Issuance of BuUdhtg Permit. d. Upon approval of thb application, the Buildin8 ln=~ctor will l~u~ a Buadb~ P~nnlt {o tl~e appacant. Such permit shall be kept on the pteinises available for iuspection throughout the work. e. No bulldinB Mtall be occupied or u~d In whole or In p~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE lo the Bulldh~8 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutbold, Suffolk Couuty, New York, told ollter applicable Laws, Ordinances or Regulations, for tim const~ctim~ of buildings, additions or alteraflous, or for removal or demolitinn, as herein described. The applicant agrees to comply with all applicable laws, ordinauces, building code, Lousing code, and regulations, and admit attthorized inspectors on premises cud in building for necessary inspections. _ (S~gnature of applicant, or name, if a corporation) (M~llln8 addre,~ or applicant) State whether ~pplicant 1~ owner, lessee, agenl, architect, engiueer, general contractor, electrlcbn, plumber or builder. ... .................................................................................. Name of owner of premises .... · ..................... , ........................ (as on the tax toll or latest deed) I[ app~ ii o c~oralion, ~natme,of duly ~odzed officer. .... (~a~e and htl~ or corporate officer) Other Trade's License No ...................... Location of land on which proposed work will be done .............................. ~, .~ ,-, ..... ............... ....... .... ................ l louse Number Street Handel CounlyT~x~pNo. IO00Seclion ...Q~ .......... Block .......... ~,,,,.. ~o[:,.. ' Flied Map No, ' Lot Subdivision .................................................................. (Name) Slale existing use and occupancy of premises and intended use and occupancy of proposed construction; a. Existing use and occupancy ............................ ~ ................................. b. Inteuded Use and occupaucy . ~.1.~ ~ ................................................. 3. Nature ofwork,/check which applicable): Ne~ Building .......... Addition .......... Alteration .......... Repair ..... '"V ........ Removal ....... :...: ,'. Demolition .............. ~.. Other Work · , . (Description) 4. Estimated Cost ................ ee ...................................... (to be paid on filing this application) 5. l£dwelling, nnmber of dwelling units ............... Number of dwelling units on each floor ................ · If garage, number of cars ................................... , .................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of ns0 ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tleight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... lleight ...................... Nnmber of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Ileight ............... Nnmber of Stories . .. ~ .................................................... Size o£ lot: Front ...................... Rear ...................... Depth ...................... Dale of Purchase .................... · ......... Name of Former Owner ............................. Zone or use district in which premises are sltnated ..................................................... Does proposed construcllon violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........................ Will excess fill be removed from premises: Yes No Name of Architect ........................... Address ............ ,~ - . Phone No ................ I~ th~.s propnrty wltthin 300 fe~c of ~ tidal w~tland? ~'Yen ..... ~.. No..~ ...... ~If y~$, Southold Town Trustees Parm:l.t may ba required. PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and, lndtcat~ ~11 set-b~¢k dimension! from properly lines. Give street and bloc:k number or descrlption according to deed, and show a/feet names ,,nd lndlcat~ whether inlerior or corner lot. II. 13. 15. ;'FATE OF NEW YORK, 2OUNTY OF..~.. (-Llc.~'O..L.W.-~.... S.S ....... ~../,~/.t~...~.... ~ &~ l~ ........... being drily sworn, deposes and says that he is tho applicant (Name of individual signing contract) I)ov~ named. le is the ................................................................. (Contraclor, agent, corporate officer, etc.) d' said owner or owners, and Is duly aulhorized to perform or have performed tim said work and to make and file this pplicalion; that all statements contained In this application are true to the best of bis knowledge and belief; and that lhe york will be performed in lho manner set forth In tho application ~led thorewHh. u~. ~o~ ~ ..... ~. _ ~ ~ ~. ,~._ l~, _/, .,~..., la g~ nl)pnc,ltl~ J Term Expires ~31/~