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Home My WebLink About14566-z FORM NO. 1~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ........ ~,!.,.~ .......Block ..... .,i~..~-n ......Lot No. ,.,.~,.,.~..,..,,~, ,.,. Building Inspector, Fee $.~...t..~ Building Inspector Rev. 6/30/80 FIELD INSFECTION COMMENTS FOUNDATION (lst).~ FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examined .~. ~~.-)r.~.', 19~..~. Approved .~. ~q~ .;z..~., 19~. [o. ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1803 Permit No, ./.~..~ .~'.~...~ Disapproved a/c ..................................... (Building ruspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ;hall 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 ;hall 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 luilding Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or >,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Itle apphcant agrees to comp y with all apphcab!e ,laws, ordinances, bmld~ng code, housing code, and regulatzons, and to dmit authorized inspectors on premises and in building for necessary ins tions.. ..... ............... (Signature of apclicant, or name'; if a corporation) ..... (Mailing address of applicant) ';tare whether applicant is owner, l~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~ame of owner of premises .................................................. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... '... Plmuber's License No ...................... :.. Electrician's License No ....................... Other Trade's License No..J,..a~., .~ ... Location of land on which proposed work will be done .................................................. ...... ..... .......... .............. l-louse Number Street Hamlet County Tax Map No. I000 Section ......... [[..~ ..... Block ....... ~ ~.9~. ...... Lot.. ~..~. 7 .......... 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 . . .~..~ ...... , ......... b. lntendeduseandoccupancy .~I:~JM~3...~ .... .~..°'?~...~..~iiiii i ii iiiii iiii 3. Nature of work (check which applicable): New Building ' Addition .' ......... Alteration .......... Repair .............. Removai ........ Demolition .............. Other Work ............... ~t~ ~2~ (Descr/ption) 4. Estimated Cost ~2~,.}.~. Fee ,~.O..~ '"---------- (to b~ 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 mixed occupancy, specify nature and extent of each t~pe of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ...... i ........ Depth ............... Height Number of Stories 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 9. Size of lot: Front ...................... Rear ....................... Depth ...................... 10 Date of Purchase Name of Former Owner I 1. Zone or use district in which premises are situated ........................ ............................. 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ...: ............................. 13. Will 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 Nmne of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& ihdicate all set-back dimensions from property lines. Give street and block number or desc~Sption according to deed, and show street names and indicate whether interior or corner lot. ;'FATE OF NEW YORK, S.S 7OUNTY OF ................. being duly sworn deposes and says that (Name of individual signing contract) .: .... - . hove nalned, y he is the applicant te is the ........................................................... : ............................. (Contractor, agent, corporate officer, etci) .f said owner or owners, and is duly authorized to perform or have performed the said work and to make and tile this pplication; that all statements contained in this application arC-true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the &ppliLation filed therewith. ;worn to before me this ............. .c~..~. ..... day of ......... .~...-~. ........19.~.~. Iotary Public, ..... . .-~-.., .- .,-~-. .... County ~._.1~_ (Signature of applicant)