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HomeMy WebLinkAbout16527-z / TOWN OFN$OUTHOLD / BUILDING D1 :PARTM£NT // TOWN ~ALL BUILDING P ~HIS MUST BE ~EPT ON P~EMISES UNTIL FULL COMPL~I( OF THE WORK iZED) N 16527 Permission is hereb' to A County Tax Mop No. I000 Se .....c:~.~ ......... Block pursuant to application dated .... ~ ..... Lot No ..... .~.~ ................ 19.~....~..., and approved by the Building inspector. Fee $..L~....;.'.~.  uuflomg Inspector Rev. 6/30/80 FOUNDATION ( ls t) FOUNDATION 2. ( 2nd ) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITION[L COMMENTS: Examined .~..I.~.., 19'~.'/. Approved .e~ .~....~.....[ .~..., 195 .'1. Disapproved a/e ............... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Permit No. I ~ :~ ~'"'/~ (Building Inspector) APPLICATION FOR BUILDING PERMIT . INSTRUCTIONS Received ........... ,19... 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. e. 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 ~ 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. .................. "~'~ -~'~ 0 c~ (Signature of appficant, or name, if a corporation) (Marling address of apphcant) \ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) , Builder's License No ~C5C[- .~..~. Plumber's License No ......................... Electrician's License No...c ............ Other' Trade% Licea~e No Location of land on which proposed work will be done~ ................................................. ' .%.. House Number Street Hamlet // County Tax Map No. 1000 Section ........ /.4': ....... Block ......... ....... Lot ................... Subdivision f.'~?.??4...k5~..C5.O?..~.....~ C~..C-'..C'~ ~'~ ........ Filed Map No ...............Lot .... %c¢...l (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existin use and occu anc ' '.~.:CAx?7~.;. k.~.~.: ~.~... ,~ ~, ~k ~ ..... \. g p y k,, · ........ ~ ', .~. '~..'~' , ~,~' ' ~ f~ ........................... b Intended use and occupancy . ~.©,.~....~.~...'...k~'k%~.c~. ~&. . . .. ... .~..~..[ ...................... .. Repair .............. Removal .... , ........ Demolition .......... Other Wor ....... (Description) (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 m~xed o?cupancy, specify nat~e and extent of each tyj~e of use ................... 7. Dimensions of existing structures, if any: Front... ~.6 ........ Rear ...~..~ ....... Depth . .~.. ....... Height ............... Numbe? of Stories ....................................................... Dimensions'of same structure with ~lterations or additions: Front ................. Rear ................. Depth ...................... :Height ...................... Number 'of Stories ..................... 8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth .............. Height Num bet of Stories ........................ .0'6 ..................... ................. 9. Size of lot: Front ,,. k.(~,,©. .... ; ......... Rear .................... Depth ', ............... 10. Date of Purchase ............. ................ Name of Former Owner ............................ 11. one or use d:stnct m wh, ~ch premises are mtuated .................................................... 12. Does proposed eonstructmn vigl~te any zoning law, ordinance or regulation: .............................. 13, Will lot be regraded .,., ..... ','q.'.~, ~ .... ' .......... Will excess fill be removed from premises: ~ ~ No I4, Name of Owner of prem:ses ~. ,~.. ,(~...65,o.~. Address ,..~.., ,~.C:,. Phone No.~...6~. :'..~Qq. CL,.. Name of Architect .......... , .................. Address ................... Phone No ................ Name of ContraetorO(.~\ .~.. ~ .~)?.q .... .~..o.~t.~.. Address .~q. ~.; .~.~..'~.-~.. Phone No ~..~.~.? ~\o.? .... 15. Is this property located within 300 feet of a tidal wetland?P~s~.°.~.~.~. No~/.... *If yes, Southold Town Trustges Permit maybe required. PLO7 DIAGRAM Locate clearly and distinctly all b~ildings, whether, existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block nufi~ber or descriptmn according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UN WFUL WITHOUT CERTIFICATE OF OCCUPANCY ApPrOveD NOTIFY ~iLDING [)EPART~T AT FOLLOWING {N~PECt ~Oi,JGH FRAMING ¢. INSUt. A1 ~T~TE CON~TRUC~O~ ~ ENERGY ;TATE OF NEW YORK, - S.S 2OU,!SrY OF .~...'~-..4r~. ~\.~.4~. ..... ,...q~XCA-~K~)q...~..· ~~ ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing,[contract) hove named. te is the ~ : (Contractor, agent, corporate officer, etc.) ,f said owner or owners, ~d is duly a~thofized to perfo~ or have perfo~ed the said work and to m~e and file t~s pplication; that all statements contained ~ this application are true to t~e best of his knowledge and belief; and that the z0rk will be perfo~efl in the m~ner s~t forth ~ the application filed therewith, worn to before me this i .................. day of....Of . .., 19 ~otaw Public, ........ · ~ ........ County ' - U ~ ' } NOR~ L. HAGER / / .. F~~ L ~ ~ .., ,Ne~~--~.~..~...3 . ~ ~ ~ 1 -- Oualifi~lnSuflolk~n~, (Si~ature of applicant) I11 -.I 0 Z 5 COURSES 8'x 8~ CONCRETE BLOCK