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HomeMy WebLinkAbout15267-z~UNDATION ( ls t) UNDATION (2nd) UGH FRAME & PLUMBING SULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ./ l~O~J~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER,AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15267 Z Perm~ssron ~s hereby granted to' at premises located at .......... ~,../..~...~~...~_.~ ........................................ ...................................... .................... County Tax Map No 1000 Sect,on ,./~' pursuant to apphcotlon doted Bud d.~,g Inspector .,ack .... ~. ........... ,or No .../.~. ....... / ~ . , 19 ~ (ond approved by the Rev 6/30/80 i0 OCCU?ANCY OR USE IS I!HLA~VFUL Wllii;:Ji EiITiFICATE I]F 765-1802 9 AM TO 4 P~ FOR FOkkOWING FO~ P~UR~ CONCRET[ 2 ROUGH -FRAMING & ~kUMBI~G 3 INSULA?[ON 4 FINAL COF~'qTPUmTION MUST BE CmFqPLFTF FOR C O ALL CONSTRUCTION S'~AI L MeET THE RE~UIR~MFNTS OF T~4~ N Y STATE CONSTRUCTION & r~, CODES NOT RESPOF'SIB' - DESIGN OR CONSTRUCTION Examined ~t~~ Approved Dmapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y 11971 TEL,: 765-1802 , l~Perm~t No IJ--~.~'~.2.--. Recezved ........... ,19. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Tins apphcatxon must be completely filled m by typewriter or in ~nk and submitted to the Building Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule. b Plot plan showing location of lot and of buildmgs on premises, relationship to adjoining premises or public str. or areas, and g~vmg a detmled descnptmn of layout of property must be drawn on the d~agram which ~s part of thru ap cat~on c. The work covered by tl~s application may not be commenced before issuance of Building Permit d. Upon approval of tins application, the Building Inspector will ~ssued a Building Permit to the apphcant Such pet shall be kept on the premises available for mspechon throughout the work e No building shall be occupied or used ~n whole or ~n part for any purpose whatever until a Certfficate of Occupa shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Bmldlng Penmt pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulanons, for the construchon of buildings, additions or alteranons, or for removal or demolmon, as herem descnl The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, an, admit authorized inspectors on premises and in building for necessary m~snectmns. ., .~ , ~ (S~gnature of apphcan~ or name, ff a corporation) (mailing address of applicant) State whether apphcant Is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or buil, .. ©~ W'r~-'t--- . ........ Name of owner o f pre~mlses (as on the tax roll or latest deed) If apphcant is a corporation, s~gnature of duly authorized officer Builder's License No ,~.~_,~., . Plumber's L~cense No Electrician's Lmense No Other Trade's L~cense No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Sectmn / ~ ~ Subd~vision (Name) Hamlet lock ,3 Filed Map No /~ Lot <~' State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction a Ex~stmg use and occupancy /~ooZ...O U..~-. /r~. [)r~C/Q ........ b Intended use and occupancy 3. Nature of work (check which applicable). New Braiding .... Addition c'"'/. . ... Alteration .... Repmr Removal ......... Demolition ......... Other Work .~*o~.~w .da<~... 4 Estimated Cost ~. ~ ......... Fee ~.~.~..~. ~ .................. (to be paid on Fflmg this application) 5. If dwelling, number of dwelling umts ......... 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 existmg structures, tf any Front .............. Rear ............ Depth ............... Height ........ Number of Stones .................................... Dimensions of same structure with alterations or addlt,ons Front ......... Rear ............. Depth ............. Height ........... Number of Stones ................. 8. Danenmons of entire new construction Front ......... Rear ........ Depth ......... Height .......... Number of Stones ........................................ 9. Size of lot Front ........ Rear ............ Depth ................ 10 Date of Purchase .................... Name of Former Owner ..................... 11 Zone or use district m which premises are situated ................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ..................... 13 Wall lot be regraded ................. Will excess fill be removed from premises. Yes No 14 Name of Owner of premises .......... Address ........... Phone No ........... Name of Architect .......... Address ............. Phone No ............ Name of Contractor ................. Address ....... Phone No ......... * Yes ..... No ..... 15. Is thms property located wzthint00 feet of a tzdal wetland? * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and chstlnctly all bufldmgs, whether ex~stmg or proposed, and indicate all set-back dnnenmons from property hnes. Give street and block number or description accordmg to deed, and show street names and mdmate whether ~ntenor or corner lot. TATE OF NEW YORK, *OUNTY OF ........... SS (Name of ind~v,duaI mgnmg contra~ct) bore named. being duly sworn, deposes and says that he is the applicant is the ................ (Contractor, agent, corporate officer, etc ) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tlns ~phcahon; that all statements contmned m this apphcahon are true to the best of hm knowledge and behef; and that the ork will be performed ~n the manner set forth m the application filed therewith. vorn to before me this >taryPubhc,