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Home My WebLink About23357-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 23357 Z Dote ........... ~..~ .................... County Tax Map No. 1000 Section ~//02 Block / LotNo ..... .~..,./. ................. pursuant to application dated .......... ~ ~ ........................... , 19 .~...~. , ..~... and approved bythe Fee $ ....... .~...~-.. ......... Rev. 6/30/80 Building Inspect~ Disapproved a/c ..... ' · (]//A~P'LICATION FOR BUILDING'PERMIT FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTItOLD, N.Y. 11971 TEL.: 765-1802 BO,\I~.D OF ttEALrtl ........ /3 SETS OF ~'L,x:tS ........ /SURVEY ................. W CIlECK ................. SEPTIC ;ORH ............ CALL ............... HAIL TO: Date .............. I INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings OR premises, relationship to adjoining premises or public sti'eet 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 issuaRce of Building Permit. d. Upon approval of this applicatiou, the Building Inspector will i~;sued a BuUding Permit to the applicant. Such permil shail be kept on the preznises available for inspection throughout the work. e. No building shail be occupied or used in whole or in part for any purpose whatever until a Certificate'of Occupanc.~ shall have been granted by tile Building Inspector. APPLICATION IS HEREBY MADE to the Building Department'for tile issuance of a Building Permit pursuaut to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buildings, additions or alteratious, or for removal or demolition, as herein described· Tile 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 ins~/ /, /~ /~.. / ' .> . , -:-' '¥x?,~x.~ (Signatureof applicant, or name, if a corporation) .... ~. >x,"~, ,] (Mailing address of applicant) State wb~tller applicant is oxvner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder· ......... ............ . · . .......... (as on the tax roll or latest deed) If applicant is a'corporation, signature of duly a'uthorized officer. ,, ., ~;.(Name aud title of corporate officer) Builder's License No .......................... Plumber's License No ............ t~ ............ Electrician's License No ....................... Other Trade's License No ...................... Locafion of hind on which proposed work will be done.... ,,,. ............................. . ................ ... .................- ........... . ....... I louse Number Street Hamlet ComHy Tax Map No. 1000 Section ./Q~J.:~~(}lock ....d~..~. ' Lot.././ ............... a. Existing use and occupancy . b. lutended use and occupancy Subdivision ........ . ............................ Filed Map No ............... Lot ............... (Name) State existing use and occup:n~cy of premises and intended use and occupancy of proposed construction: · .' ........... .~.~.~o**~..DlJgOq Yfi~O~ ............. k ( ppi ) ' .3. Nature of wot check which a mab e : New Bnilding . Addition .......... Alteration ...... pai ~ .P,e r .............. Rem val ........... Demolition ..... : Other Work 4 Estimated Cost ~¢ ~ ~ ~ ' (Description) ' ' ........................ Fee ~ ts .......... (to be paid on filing this application) 5. lfdwelling, m,nber of dwelling mi Nmfiber ofdwe ' ~ t . If garage nm berofcars mg nltsoneach floor .......... 6. Ir business, commemal or,mxe4 occupancy, specify nature and exten}o/&h'tyi, ;rni ........... 7. Dimensions of existing stmcture~, if any: Front ........... · .......... ~?gbt...~2'...:..... b tories,.. '. Rear .. Depth Num er of S '. .......................... ~m~ensmns ofshme structure with a ~ ..... ]"/ ........................ Depth .... ' ; ................. Rear ..... ~ .. ...,.Ilmght ........ . ............ 8. Dimensions ot enure new coostniction: Front : ......... ... Number of Stories ............ ' ..... Heg~t . Nnn; ._ . ....... : Rear ............. Depth . ' .............. 19er ot Stories. . .......... 9. Size of lot' Front /oo~ m O ~. ................... · · · · .e ..... ~. ~ ...... lqear . .~ ~ ......................... 10. Date of Purc rose ~ ~. · . .O~ ............ Depth~-R ~g.~ ~gO ~- . . '" ................. . of ormer. .. '"' ' ........ 11. Zone or use d,stnct m which pre~ises are situated ~ ,~a ~&'..~X ........ ' 12. Does proposed construction viola're anu -~,,;-- ~ -. 13. Wi 0t be re faded ~. , ....... a ,aw, ormnance or regulat on 14. Na~ .... ~._ ~_ ~ ~& ....... W 11 excess fill be removed rom premises' Yes ~ ............... Addrdss ................... Phone No .......... ' ' ' Name of Contractor .......... ~ ................ Address ............. . ...... Phone No ........ ' "' ' ' tS.' ~.s cb~s property wlch2n 300 feeC of a c~dak wet,and? *Yes ........ Ho.~ .. ' .... · ~f yes, SouFbold T6~dn TrusCees Permit may be required. "' · .i PLOT DIAG~ Locate clearly and distinctly all bnildings, property lines. Give street and block nfimber or interior or corner lot. wbeth&r existing or proposed, and. indicate all set-back dimensions from description according to deed, and show street names and indicate whether ~. FOUNDATION , TINO REQUIRED FOR POURED CONCRETE " ' 2. ROUGH. FRAMING & PLUMBING ~ 3. INSUlaTION ~,~ 4. FI.NAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTs OF .THE N.Y. STATE CONSTRUCTION & ENERGY CODEs. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR8 rATE OF NEW.-YO4~, r~ ....... ' ~ ] ' G~r. bengduysworn '~~~ltract) t ...... , deposes aud says that he is the applicant ~ovo named. ' 3 iS the , .. . ., ............ ~ . ....... , .. ........ ........ . ............ ' '" 'porate officer, etc.) saki owner or owners, and is duly authorized to perfom} or have performed 'tl~e saki work and to make and file this plication; that all statements c6~tainedlln Hds'application are true to the best of his knowledge and belief; and [hat the )rk will be performed in the manner s&'t (ortb in tim Jpplication filed therewith. ,'om to before me this ~. ......... ~... of ............... 9~ ~o. 4~. ~uo~a ~u~ ........... (~iRnntllro