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Home My WebLink About16888-z FO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWH HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to. __ ..... ~, :~Z_~"'~ ~ ....... /,';;"~ . ~ "7Z"-'~'~':7.~'~"~/'""~'_'~/' ....... ,o ....~..~.~~....~~ ....... ~.....~_..~.~ ............ ..............................................~-,-,-.-~-~/_./~.~ .......... :v ................................................ pursuant to applicat,on dated ......... ..~.~..~.. .... Building Inspector. ............. , 19~..~., and approved by the Rev. 6/30/80 BLDG D£' T TOWN OF SOUTHOLD TOWN HALL .............. $OUTHOLD, NY 11971 TEL.: 765-1802 Bxaillllled ~3 , i9~;~t~' I-OItM NO 1 SURVEY .......... TOWN OF SOUTHOLD CII FCK ......... BUILDING DEPARTMENT SgpTTC FORPi ............. I'IOT T FY . .... NAIL, TO Disapproved a/c (Btuldlng Inspector) APPLICATION FOR BUILDING PERMIT Date [ , INSTRUCTIONS a Ttus application must be completely filled m by typewriter or m ink and submitted to the Braiding Inspector, with sets of plans, accurate plot plan to scale Fee according to schedule ~ b. Plot plan showing location of lot and of buddings on premises, relationsh~p to adjoining premises or pubhc stree or areas, and giving a dettuled descrlptlon of layout of property must be drawn on the dmgram which is part of this appl cation c The work covered by tlus application may not be commenced before issuance of Budding Permit d Upon approval of th~s application, the Bmldlng Inspector will issued a Bmtdmg Permit to the applicant Such perm shall be kept on the premises available for mspectlon throughout the work e No budding skall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan: shall have been granted by the Bmldmg Inspector APPLICATION tS HEREBY MADE to the Bmldmg Department for the issuance of a Bmldmg Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as hereto describe, The apphcant agrees to comply w~th all apphcable laws, ordinances, buzidmg code, housing code, and regulations, and , admit authorized inspectors on premises and m bmldmg for necessary inspections (Signature of applicant, or name, if a corporation) (Malhng address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullde . ... Name of owner ofprem,ses . A, C(:2>AJ ~'b0 t'~ ... (as on the tax roll or latest deed) If apphcant [~/a co~n, s~ly authorlzed officer · '~((~m; and t,tle' o f ~orporate officer) '' ALL COI'ITRACTOR~S 1.lUST BE SUFFOLK COUNTY LICgI~$ED Builder's L~cense No .1~ ~ 1.4~ 1 Plumber's License No Electrician's L~cense No Other Trade's Lmense No Location of land on which proposed work will be done House ~mbcr Street County Tax Map No 1000 Section / ~__~2~ Block Hamlet Subdivlston " (N'ame) Filed Map No Lot .. . State existing use and occupancy of premises and intended use and occupancy of proposed constructmn a Existing use and occupancy b Intended use and occupancy ................... 4 5. 8 9 10 11 12. 13. 14. Nature of work (check whlcll applicable) New Building Repair Removal Demolition Estimated Cost 4,-g._t~:2a::::n~> ~':'.° . . If dwelling, number of dwelhng units If garage, number of cars Addition . Alterat~n Other Work (Descnpllon) Fee ..... " (to be paid on filing this apphcat~on) Number of dwelling units on each floor If business, commercml or mixed occupancy, specify nature and extent of each type of uae Dunenslons o f existing structures, if any Front Rear Depth .. Height Number of Stones ............ Dunenslol~.s of same structure with alterations or additions Front .... Rear .... Depth . Height .... Dimensions of entire new construction Front Height . Number of Stones Size of lot Front Rear. Date of Purchase Zone or use district in which premises are situated. Number of Stones ..... Rear .... Depth ....... Depth .... Name of Former Owner ... Does proposed construction v~olate any zomng law, ordinance or regulation .......... /~'.~9... WH1 lot be regraded ...... Will excess fill be removed from premises Yes Nc Name of Owner of premises . . Address ........ Phone No . . . Name of Architect ........... Address ....... Phone No ...... Nmne of Contractor ........... Address ........ Phone No 15. Is this property located wzthin 300 feet of a t~dal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permzt maybe required. PLO]' DI AG P-~.M Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property hnes Give street and block number or descnptmn according to deed, and show street names and indicate whethe~ interior or coruer lot APPROVED AS NOTED '-~ 180~ 9 Ak~ TO a ~M ~R ~E : OL' OW'NC INk, PFCTM ~OUN~A~IO~ ~310 REQUIRED ROUGH ~IN(~ & PLUMBING 3 IN~ULArlO~ ~ ~iNAL C{~N~TRUCTtON M[JST AL~- ~]OI~ATRUCTION SHALL ME~ , HF ~E~UtP~MENTS O~ tHE N.Y ~TATE CONSTRUCTION & ~NERGY CODES NOT R~SPO~SIBLE FOR m~lGE 9h COP~STRUCTION ERRO~{ STATE OF NEW YORK, COUNTY OF SS (Name ol individual s~gning contract) ,~oove named being duty sworn, deposes and says that he ~s the apphcant He ~s the .... (Contractor, agent, corporate ofhcer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file thl~ application, that all statements contained m this apphcation are true to the best of his knowledge and belief, and that the work w~ll be performed in the manner set forth m the application filed therewith. Sworu to before me this Notary Pubhc, . . .. County