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Home My WebLink About23083-ZFO~'M NO,$ TOWN OF $OUTHOLD BUILDING DEP,~RTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .................... NP 23083 Z /0 XlO Permission Is hereby granted t,~, , ~ /. ..... ~..~ ........ ~..4.,~ .......................... '"~':'~'"" '/'~'"i ............................. ~~,,,~,~.~,,,,,Y,,,,,.i~..~? . ....... .... at premises located at........~.~...~...C?..~.... ........... ~....~...f..'. .............................. co,,~To~Mo~o. ,ooo s~:,o~ ...... ~. .Y....i. ~,o~ ............ ~.. Lo,~.: ........... pursu,nttoappllcatlondated ............. ~.~./...~.. ........... 19....~.U~..... an/ ,approved bythe Building Inspect~..~ Fee $.....~.....~........~ Rev. 6/30/80 Building In~ ~ . ~. ; . TOWN OFSOUTUOLD ', 00'[ [ ~ 199~ BUILDING DEPARTMENT.. ~E Ld~7C~. ........ TOWN I IAL L Disapproved a/c ...................... :-:' ....... ] . .: . ~PLICATION FQR BUILDING PEr, MIT BOARI) OF IlEAl. Ill ........ 3 SETS OF PLA~tS ........ SURVEY ................. CIIECF. .................. SEPTIC FOR/I ............ CAI. I, ~ ................ i~lA I L TO~ l)ate , / ........ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submilted to the Buikling Inspector, witi~ sels of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocalion of lot and of buildings on premises, relationship to adjoining premises or public state or a~eas, and giving a delailed desc~iplion of layout of properly must be drawn on the diagram ~vhicb is part of this al)pi cation. c. The wink covered by this application may not be commenced before issuance o} lhdlding Permit. d. Upon applovaloftbisapplication, the Building lnspector will issued aBuiklingPermiltolheapplicant. Sucbperm shall be kept on the premises available for inspection throughout Ihe work. e. No building shall be occupied or used in whole or in part fo~ any propose whatever un/il a Cedificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MAI)E to the Building Deparhnent for the issuance of a Building Permit Imrsuanl Ihfihling Zone ()~dinance of {l~e Town of Southold, Suffolk Cmmty, New York, and other applicable Laws, O~dinances Regulations, for the construction of buildings, additions or allerations, or for removal or demolilion, as herein descdbe~ The ~pplicant agrees Io corn >ly with all applicab e ws orr inances, bu ld g cot e hous ~g cot e, a~ ~ tee a ions and admit authorized inspectms on premises an~l, in building for necessary i~~'~ " ' (Mailing address of apl~licant) State xvhelher applicant is owner, lessee, agent, archilect, engineer, general contractor, electrician, plumbe~ or builder .. ........... (as on Ihe tax roll NOTI~ 8UIL~INO Iqmnbm's . cerise No ..... 8..IN~ l.Jechlcl s License No. ~ ~' ~ BE~I'~O. ...................... A~ CONST~I~ 8HA~ (mt,., ~ ,des Dee se No ...................... .~ ~0~ ,STA~ ~O~ON ~ ............................................. .......... . ............. Ihmse Number Sh'eet ~ · IlamleC: ; . Subdivision .................................... . Filed Map No ............... (Name) ............... Shne existing Use and occupancy of plemises alld intended use all(} OCCll )allcy of proposed coIIStltlclioll: ,,. a,,,, ............. 3. Naluleufwolk (cbeckwbcbapplicabte): New Building v/ Addition .......... Alteration Repair .............. Removal .............. l)emolition .... : ......... Other Work .............. ,1. l~stimaledCost $ / O ~ (I)csclil)li°n) ...................................... Fee ~ (lo bepaidon fi g isa))licalion) 5. If dwelling, ,mmbel of dwelling uqils ...... ~/~ . . Number ofdwel g , s o e c Iloor ..... ~ ...... Il' garage, number of cars ..... ~ ............... . ...... ~.. 6. s ess co ,,nec or ,xe, cc(,, cy, si,cc Fy ,,a ute an,I exle,,t of each type or use 7. Dimensions of existing structures, iFany: Front ....... Ileigbt ............... Nmnber of Slot;es ...... ~ .... Rear .............. I)~plb ............... l)imensJons of silme slructure wilb alteralions or additions: Fro~ De ) · · · Re; r I)o~s I)rOl)OS¢d conslruclion violal~ any zoning law mi nance or regulalion . , . ~ ~ , :. 'ti ...... Nam~ of Al'cl~il~cl ...... O~b~ .............. Address L ' y.s, Southold Town Trustees Iermit ]nay be required. ~:2 ~ " PLOT I)IAGRAM .ocale clearly and distinctly all buildings, whether existing or propose( an( indical~ta Ct?go~rsti~l~psions )roperty ~treet and block cumber or descriptio ~ accor ~g lo deed, ant s~w stre~t;i[ali?~nd i~id'i~le whether .... 4~'~..'~...."-~..'...~..C....k~..~q?~. ........... being duly swo,',l, deposes and says that be is thc applicant (Name of individual signing conh'acl) rove mm~cd, (Contracto[, agent, COl I)orale officer, etc.) .... saitl o;wler o~ oxvners, and is duly authorized to perfo[m or ]lave performed the said work and lo make and file this qflication; that all statements contained in this application are /'rue to lite best of his knowledge and belief; and that the o~k will be perfom]ed in tim manner set forth in the application filed therewilb. · yom to before me this/ ........... L. or. Term Ex,res Ma, 31.19~ '