HomeMy WebLinkAbout15343-z FOBM NO. ~
TOWH OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDii,IG PERIvIIT
{THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 15343 Z
County Tox Mop No. ~000 Section .... ..~....'~..~ ......... Block ..... ..1~...~. ......... Lot No. ~
pursuont to epplication dat~ .~~...~....., ,9.2.~, and opprov~ by the
Building inspector.
Building I~tor
Rev. 6/30/80
New York Sta~ Uniform Fire Pmve~flon and Building C~e
E~e ~arch 25, 1985
~ ~.4 U~ ~ ~. gum~r w~Jch ~s not ~de m~k~ nor ce~fi~
by a ~i~ ~g o~an~afion d~gnat~ ~d~ ~cfion 802.2 ~h~ ~ cla~fi~ as
o~n~ matefi~. Su~n Immber is not ~ to m~t ~e test ~menm of Pm 8~ and
may ~ au~ f~ ~ by [he aurora, having j~cfion under ~e fogoaSng con~tions:
~ ~e g~ucing mffi s~all ~H or pffivide ~e lm~r ~cdy to ~e ~fimate consum~
b:~e p~ucing mill sh~l ce~ ~n ~ting m the consumer or builder on a fo
pm~d~ by abe t~al au~fiW having j~cfion t~t ~ qu~i~y and ~fe working
s~s of such lm~r ~ equal ~o or exceed No. 2 ~de in acco~nce ~ ~e
mn~fions ~t fo~ ~ ~e ~e~can ~ Stand~ ~20-70. ~s ce~ficafion
a~licafio~
c. Suc~ lmm~r ~1 ~ ~ Ln acco~oance wi~ P~ 705, ~t~ m:
(i) one- and m~m~y a~ multiple dwe~ngs not ~ng ~ st~
(~) gen~ b~g mns~cfion not exc~ng ten ~o~d ~ f~t of
~m~afive fi~r ~ or 35 f~t ~ heigh[
· Such ~m~ lum~ ~ ~ ~mi~ to ~ u~ as pmvS~ ~ sub~fions (a),
~) ~ (c) ex.pt w~n it h~ ~n detemin~ by ~e 1~ au~ ~vingj~cfion
· at ~y lm~ whch is ~dd acmr~ag m the Amefic~ ~
~20-70 m~ ~ ~ ~ s~h muni~p~i~-.
~.5 C~ ~ ~ ~ S~aces m ~ ~ld~ in cop~r tu~ ~!der join~ shall
d~ ~gh~ ~m~ fl~ and ~e joint made ~ mld~ appmv~ for such ~.
~ntent in ml~ ~ ~ ~it~ m 0.20 ~r cen[
E~flve Mamh 25, 1986
~ 1~.~ F~ ~fion p~ms for ins~lafion and c~cafion of mlid
b~g ~g a~li~ c~ne~ ~d flues u~ ~ a residence ~ ~a~ t2~.2.
l~.l~ ~ ~fi~ ~l ~ ~y con~ct~ to ~ ~gh~g clot of ~ dwe~ng ~it or
d~p~g mm ~ ~ inhering w~l s~t~. Coffi-conn~t~ ~a0oas ~
E~t~ve Mamh 4, 1986
1193~. At !~ one ~gle ~afion smoke dct~fing ~ de~ sha~ ~ ~ on
submi~ at ~ fi~ ~ ~ ~fer ~ca~g hMt such smoke det~g ~ ~
~A 74.
E~tl~ ~amh 25, ~ 986
1193~. At l~ ~ ~e ~n ~o~ tieing ~ ~ce ~y ~ ~ ~ or ~
~g ~ ~ch ~ ~ ~ ~p~g uffit of e~fing m~fiple dw~ ~ co~W
wi~ ~on 1~.10. ~e~ o~t~ de~ ~ ~miRM ~ ~ ~ ~fe~nce
~ ~PA 74.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
,,°OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ~..~..~., 19 .~.[?.
-- ~ ......... =.q., ............ 1 ~,~-E
Approved~R~ 19~. Pe~it No
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PER~IT
BLDG. DEPT.
TOWN OF SOUTHOLD
Received ........... ,19..
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. :~
· ..................
(Signature of d~licant, or name, if a corporation)
....... ~ ..- ...... ' .... t...~ .........
....... (mailing'~ress of appl%ca t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Name of owner of premises
(as on the tax roll or latest de~4) ~.~ .,
If applicant is a corporation, signature of duly authorized officer. D
~ ~'1 CAB.
..................... . . ....... . . : tF ..................
House Num her Street Hamlet
Co,nt lO00 S tion .... 3 ] ........... mo,k ............. .............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . ."f~...~..1~..~.q~?,."~......~1~ ~ .....................................
b. Intended use and occupancy . .~.(~ .~..~.~..r.7'~../.~...~...,.
3. Nature of work (check whiqh applicable): New Building .......... Addition .., ........ Alteration ..........
Repair .............. Removal .............. Demolition ... ~ ....... Other Work ...............
· ~'~,~- !! (Des c riptio n )
4. Estimated Cost ...................................... Fee .~..~,'~..~. ~ ......................
(to be ipaid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling uniis on each floor ................
If garage, number of cars ............................................ i ............................
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 ....... i ....... Depth ...............
Height ............... Number of Stories ............................ i ............................
Dimensions of same structure with alterations or additions: Front ............ I ..... Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ........ ! ....... Depth ...............
Height ............... Number of Stories ............................ i ............................
9. Size of lot: Front ...................... Rear ...................... iDepth ......................
10. Date of Purchase ............................. Name of Former Owner .i ............................
1 I. Zone or use district in which premises are situated ......................... i ............................
12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................
13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .................... Address ............... i ....Phone No ................
Name of Architect ........................... Address ............... i ....Phone No ................
Name of Contractor .......................... Address ............... I ....Phone No. '~k; ............
15. Is this property located withinl.00 feet of a tidal wetland? *iYes ..... No ~..
· If yes, Southold Town Trustees Permit may be required. ~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW yORK, ~ ~
COUNTY OF ..~/~ ~'~ ,
· . '[/./.~..~ .-F.c.cc//4./~..5~.../~..'~./~..z~. ...................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ~ ~ '
(Contractor, agent, corporate officer, etc.)~
of said owner or owners, ~d is duly autho~zed to perfom or have perfomed the s~id work and to m~e and file this
application; that all statements contorted ~ this application are true to the best of his~knowledge and belief; and that the
work will be perfomed in the m~ner set forth ~ the application filed therewith.
Sworn to before me this
................ /...~ .... ~ ........................ 19
Nota~~Public,. ..................... ~~ County
No. 482286~, 8~k
Term Expires ~m~r ~, 1~ ,