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Home My WebLink About16042-z l~ ~-~o~'~ .............. _~!_'- ~" _~'o', ............................ ~:_~ ..................... 5ERV CO~5T "" L7 .: OUNDATION ( ls t) OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FI~;AL . ADDITtONA'L COMMENTS: 'FO\~Jh' OF COU ;'HOLK1 d/,,, BOARD OF HEALTH 3 SETS OF PLANS .t~..6~'...... . 'FORM NO. 1 SURVEY ......... , ' TOWN OF SOUTHOLD CHECK .......... BUILD~NGDEPARTMENT SEPTIC FORM - TOWN HALL , NOTIFY SOUTHOLD, N.Y. 11971 7.~.%T'.-J.'-~ TEL.: 765-1803 CALL · · MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 7 Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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. 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 in building for necessary inspections. ............ ~ (Sig~l~ture of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . · .~.. q"~..A.tr.._~ · · .~..~. '~'.~..~. 1:%.~..*--~ .................................. ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY Builder's License No .......................... LICENSED Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. · ~..~:%. L,~,~,--r-~-v~.~l~'.a~7,., ~,1/~, ~ . O. Crp..... . ....... ,,, .(_ .................................. House Number Street Hamlet . County Tax Map No. 1000 Section . .t'..~.. ........ Block '7' ............... Lot...~,, ............... Subdivision..~,,~,o_.,~....e~[ .o,kV_ ............... Filed Map No..'~. ~..~- ......... Lot . ~..,~-. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~ .~ .~-x \ .,--~'.t ~.~.~ :T~'.~. ~-~,~-~ . b. Intended use and occupa~--y ...~..~-z.' .~.c. ~ .... . i"/~. ~.~.. · .~. ieee.. ....... 3. Nature of work (check which applicable): New Building ..... ' ..... Additl ...... Alteration ........ ,. Repair .............. Removal .......... ........... Demolition ?n .... .... OtherWork .e~. . ~ ..- , ~ ~ 1~O(Descrip'ti°n '4. Estimated Cost...~. ~ .o..~. 77-. ....... . ................ Fee~...'~'. ...... (o..L/, .... . . ~ , (to be paid on filing thru apphcat~on) . If dwelling, number of dwelling units ........... Number of dwelling units on each floor ............. Ifs ' : arage, number of cars ....... '6 dd ............................ ~ ........ fY h typ ' ' : If business, commercial or mix occupancy, spem nature and extent of eat e of uso ~ ~, 7'1Dimensions of existing structures, if any: Front.,,.,.~...... .... Real' ...~.;,.,,.~" D0?~li"/ Height Numb r of Stories ..... ~ "' ...... ;~ il Dimensions'of same structnre With alterations or additions: Front ............ , ..... Rear ....... ,, .... Depth ................... :... Height ................... Nt, n,b'. ,~' of St;orloa .........., ...... 8 Dimensions of entire new construction. ~ ~ ~..~. ~. ¢ Rear Deptil ' Height Nmnber of Stories '. /4-o , ,, ' .... . ,, ' , · 9 Size of lot: Front ................... ,.. Rear,.,./ ..... ~ ............ Depth ,~,, ~. ~ ........... 10.i Date of Purchase ........................... Name of Fro'met Owne? I 1. Zone or use district in which premises are situated ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: , P~/.q ........................ '13'.: Will lot be regraded ...... '2b,~'~"'", ...... ;'" a"l'"'Willexeess fill be remQyed from premises: Yes 14. Name of Owner of pre~nises ',l). !.~ .-,:,. ~<;,,~..~..~v~ . -~> Address ¢.t..o...~.~.~:,~.¢o.~ov~,, Phone No ............... Name of Architect Address Phone No Name of Contractor Address ' Phone No 15. Is this property located within 300 feet of a tidal wetland? ~Yes ..... No · If yes, Southold Town TrUstees Permit maybe re¢iuired. ' PLOT DIAG IL'kM , Locate clearly and distinctly 'al! buildings, whether existing or proposed, and. indicate all set-back dimensions frc property lines. Give street and block: number or description according to deed, m~d show street names and indicate whetl interior or corner lot. STATE OF NEW y~oRI(., S.S COUNTY OF' ....... .~.~.=o..q ~-.~, · . .~..a~,'""~ ~.~. !~ ~ ~*. ~ '.. ~ ¢.'f ~'~ ......... being duly sworn, deposes and says that he is the applied, ':"' ' (Name of individual signing contract) above named. He is the, ~ .,~ .~.~ .~. JSe.~ ....... -,....~ ................ ... .................................. ~ ~. , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to m~e and file th a~plication; that all statements con~ained N this application are true to the best of his knowledge pnd belief; and that ti: work wQl be performed in the mannor set forth in the application filed therewith. Sworn to before me this ....... , .... ...... d yOr.. ....... ...... t o a~y ublic .......... -.. .~ .. County ?, ~ HKE~ ~ DE ~[~BLIC, ~e ~ ~w Y~ ~ (Signature of applicant , ~. 4707878, ~flolk ~n~