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Home My WebLink About8536-Z FOB~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FE~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Building Inspector. · ' Inspector TOWN OF SOUTHOLD PI~OPERTY RECORD CARD OWNER FC~R. MER OWN~ER t~r~_ C)~S I ST~E~i' ~_~i~;/'~:'? ~ . VILLAGE DISTRICT SUB. wC_.,,~/,~_~z :~· ,.!'~'~:~ , ~WO ~ ~Y~ / ~MOoW /wPE OF BUILDING LOT SEAS. VL. FARM TOTAL DATE IMP. REMARKS~ ,- 2~" Z AGE BUILDING CON D ITIO~N NEW NOP, A4AL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Total BULKHEAD ? DOCK . ,. i, !) M. Bldg. Extension Extension ~dation Basement Ext. Walls Extension ; Fire Place Heat ~. ,~, ~.,., ~ ~r.'-~' ~ ~...~. / I~ q. ~,C~ / ~1 /~ ~ , ,, .~ I Porch Roof Type , B[eezeway ~ " " · : ' ~ ~W'---~ --t~q' ¢" ' '~ ~' -~ -~ Garage ~~ ~ ~ ~_~ ~' Driveway ~ = Dormer FOKM NO. 1 TOWN OF ~OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c -~ (Bui aing nspector~ APPLICATION FOR BUILDING PERMIT Date ......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit-~ 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 Occupancy shall have been granted by the Building Inspector. Builder's License No ............... .~. .......... ~ .................... Plumber's License No ...... ,; ......................................... Electrician's License No ............................................. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to__ admit authorized inspectors on premises and ir~ buildings for necessary inspections. .................. .............................................. (Sigr~ure~f applicant, or name,~f a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .....~.~....~...~ .......................................................................... // // If applicant is a corporate, sig~,~ure of dul~ authorized officer. (Name and title of corporate officer) Other Trade's License No ............................................... Location of land on which proposed worJ~vill be done. Map No.: ........................................ Lot No~_ ........................ Street and Number ......... . .~....~...~-f-~/,J~....~....~_...~ ..................... / Municipality State existing use and occupancy of premises and intended us~ and occupancy of propGsed construction: a. Exisiting use and occupancy ....... ~~~.~....~.....~ b. Intended use and occupancy ..... Ncl-ure of work (check which applicable): New Bui!ding~ ...... Addition .................. Alteration ....... ~ ..... ~r 3 Repair .................. Removal .................. Demolitio~ .................... Other Work .................................................. (Description) 4. Estimated Cost .................... ~...~..~. ........... Fee (to be paid on filing this application) 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 nature and extent of each type of use ........................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~.......-~'. ............... Rear ....... .~.......~.. ......... Depth .....~......-Z~. .......... Height .................... Number of Stories ................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ ~ 1. Zone or use district in which premises are situated .................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ I3. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 4. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... h!ome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propc:rty lines. Give street and block number or description according to deed, and show street names and indicate c/bather interior or corner lot. FT.ATE OF NEW YORK, COUNT',z OF ..... St~£kPO]-~ .......... j.S.S ................................ ~....~..O,~e~...Qau~oe~qbeing duly sworn, deposes and says that he is the opplicom (Name of individual signing contract) above named. He is the ...................................................... .0~_8.~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicction are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ 2_(~.'t;.t'3. ...... day of ....~.~o~d, Et ............................ , 19..?~. ~ J-. Noto Pub,c,. ................................. .Coun .............................................. ~IJ(Signature of applicant) EUZAB£TB .~NN NEVI/L~ NOTARY PUBLIC, State al New Yolk No 52-8~25850, Suffotk County.~ Term [xl)ir~s March 30. 19~. ~' It appears that the work approved and authorized under building permit No. ~...'~....~....~.....~.., Dated ~f~..~......?.f... is completed. No application for certificate of occupancy has been received by us os of ............. ~ ~,/. ....... .r.Z...7../.... O~/~ ~ Please file for your certificate of occupancy as occupying or using a building or structure without a certificate of occupancy is a violation of the zoning ordinance Article XV, Section 1504 Building Inspector