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HomeMy WebLinkAbout14995-zTOWN OF SOUTHOLD BUILDING DEPARTMEt4T TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereb/granted to: .............. ...~.~C...~.~ ..~....~ .................. ~...~...~.~.....~....~.,. ................... ~ ................................. 'Z';;' ............ ; ......... ~z~ .......... ; ............. '-- ............ ~ ..................... ; .............. ot premises located at ...~,..~...~,......,~.....x~...~.~ ........ ..~......at~...,.~........ ,~...~ .......... County Tax Map No, 1000 Section ..... .0......~'...-'~.. .... Block ..... ..(~.....~m ...... Lot No ..... .~.1 ............... to o~pI~ca,on da,ed .~...~.~ ..................... , ~.~.~., ~.~ ~.o.~ ~ ,h. pursuant Building Inspector, Building Inspector Rev. 6/30/80 FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .... ,'~-~...~-~...., 19 ~.~. Approved. i .~...~..., 1~.~.. Permit No. ! .~. ?.~. ·~. ..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ~R 2 5 1986 LC' TOWN 9F 'SOUT~OLO Rece±ved ........... ,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 he~in described. The applicant agrees to comply with all applicable laws, ordinances, building code, hocsing coCje, ~d reg~ations, and to a dm it au tho rized in specto rs on pr emises and in building for necessary in spec ti ons./~_ ~ ,.~ [['~'~ '~~ ' (Signgliure_~ffZ~,pplica. jl~ or h~//ne, if ~t corporation) ...... ..... ....... o ...... ( · g PP ' State whether applicant is owner, lessee, agent, architect, en=ineer, general contractor, electrician, plumber or builder. NOTI#TM B' t!LF~ING DEPARTMENT AT (Name and title of corporate officer) 765-180,2 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: BuJ, lder's License No .......................... 1. FOUNmATION - TWO REQUIRED FOR POURED CONCRETE Plmnber's License No ......................... 2. ROUGH - FRAMING & PLUMBING 3. INSULAT~©N Electrician's License No ....................... 4. FINAL. C©N%T~,Llr'TION MUST BE C©MPLI:TE FOR C.O. Other Trade's License No ...................... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. I. Location of land on which proposed work will be don~e ................... .,.. 8T,~T.[ .CONS. T.F~uC.T?_.N: ..~&..~..~N.F:R~Y~ , ~ ..................................................... ~. / %~%~.~ CD. NSTgUCT.19H gF~ House Number Street Hamlet ..... O.X .... ,,o k .... & .......... ..... ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy ~ proposed construction: ;'yls?? nd.o "p'n y ................. .... .... ........................ ,. mtenae~ use and occupancy .................... [~~ ..................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .......... I ....Other Work.... ,/~7~.....~.. ' (Description) 4. Estimated Cost ................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelhng umts on each fl ....... ............... eot ......... If garage number of cars ' 6. If business, commercial or mixed occupa~ncy, specify nature and extent of each t~pe 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 6f Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ~ Depth ..... Height Numb f Storie ' : ............... er o s ........................... , ............... 9. Sizeoflot: Front ...................... Rear ...................... i Depth ................... . .. 10. Date of Purchase ............................. Name of Former Owner 11. Zone or use district in which premises are situated ....................... ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ...! .... 13. Will lot be regraded ............................ Will excess fill be remo{ed from premises: Yes No 14. Name of Owner of premises .................. .. Address .............. , .....Phone No ....... Name of Architect Address ' Phone No ' Name of Contractor .......................... Address .............. i .....Phone No ...... 2 ......... 15. Is this property located within 1100 feet of a tidal wetland? ~ Yes ..... 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 sh6w street names and indicate whether interior or corner lot. COUNT~-O~ ...... a'~ .~~~. ': ~ ~..c-~.. ...................... being duly sworn, deposes and (Name of individual signing contract) above named. He is the ........................ ~ ....................... (Contractor, agent, corporate officer, etc.~) of said owner or owners, and is perform or have performed the ~aid work and to make and file this duly authorized to application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. .... ........ tary Public ....... '.../~ ......... County , Suffolk County ,~ Comm#~lon Explre~, July 31, says that he is the applicant (Signature of applicant)