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Home My WebLink About22704-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. Ne 22704 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ............... ~,~., .......................................... CountyTax Map No, lO00 Seotion ...... ~, ,.~,,, ......... Block ....... ,~.,~.,, .......... Lot No ..... ,..~..~ .......... pursuant to application dated ................... . .~../.,..~... ....................... 19.....~..~.~...'~.., and approved bythe Building Inspector. Fee 0.... ,,~'..~...: ........... Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... BOAaD OF HEALTH ......... 3 SETS OF 'PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. t:OT I P¥ ~ CALL ................... HAIL TO: . /(/[~f~ding Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This 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. I~. Plot plan showing Iocation 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- :atiEn. c. The work covered by this application may not be cbmmenced 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 Southold, 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. ?he applicant agrees to comply with all applicable laws, ordinances, l~u~kliag code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary Cspect/i~n.s. -- (Sign~plicant, or name, if a corporatio'n) ' ' grate whether applicant is owner, lessee, agent, architect, enginee ira l~ctrician, plum~er or builder. qame of owner of premise · -ff~'~/.~. · .................. .~PP[~[}.~ ~01~1[~ ..... · . (as on the ta'l'roll or latest d, ~.. ~B.~#. ~tE~/~-~-, f applicant is a corporation, signature of duly authorized officer. " --~. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE Plumber's License No .... . ./~. ~. ................ Electrician's License No....~.~. ............... Other Trade's License No...~...~. .............. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIREO FOB POURED CONCR" ii" 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE BTATE' CONSTRUCTION & ENERGY Location of/and on which proposed work will be-done, CODES, NOT RESPONSIBLE FOR ..... ..... .......... ................... House N~ber Street Hamlet ,ooo ..... Subdivision ........................... . Filed Map No. ..... ~..... . ............. Lot ............... (Name) . State existing use and occupancy of premises and' {n~dfided use and occup~y of proposed construction: a. Existing Use and occupancy .... ~ ....... ~tD .;~.!~ta~ ............ b. Intended use and occupancy ............ 3. Nature ' ~ · of work (check which applicable): New Building .......... Addition . .~t~tion, s...~7 . .' '. .... Repair .............. .. RemOval ............. Demolition ...........(~.. OtherWork~ 4. Estimated Cost ...... 7' ' 'i, ................ Fee ...................................... (to be paid on filing this application) f . 5. I dwelling, number of dwelling Units ... ~ ...... Number of dwelting units on each floor ................ . If garage, number of c~s .... · t ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each.type of uso ..................... 7. Dimensions of existing structureS, ~Fmnt ............... Rear .... ~ .... c7'.~. .. Depth ............... Height ............... Number of St~s ............... ,~ --~'~ ..... D~ensions of same structure wi~h akeration~dditions. Front ' ~ '~' ...... ~22- ' .............. Depth. .................. . · .. ~. Hei~te~ ...... ~ ............ ~NumberofS~o~;s~'~~ .~ ' . ' ~..'. 8. D,mensmns ofentirenewconst~ction: Front .... ~, ~ Rear . .' ~;p}~ :~': "' .' Height ............... Num6er of Stories ...... ~(~ ...................... 9. Size of lot' Front . i ~__: '~ .... ~<' ........................................ .... ' . ' ......... [ .......... ~e~ ......... ex .......... Depth .................. I0. ~ate otrurcnase ......... i ' . .~ . Name of Fo~r Owner . . . 11. Zone or use district in which premises are s~ed ..... ~'~'~ . ' ...... ~': ................ 12.D°es proposed construction violate an~ing law, ordinance or r;~{a}iln~ ............... ~.~ .... 13. 5ill lot~regrad? ......... ~ ............... Will excess fill be remo~from premises: Yes No 14. ~me or ~wner et premises ,~ ....... Address · · Phone N N ~- . ~ . ' ...................... ~P o ............. N~e o[ ~rch~tect ....)z ..... ~ ................ Address ................... ~bone No ........... ; .... e or contractor ~ ....... ~ ............. Address ................ Pho~-~o ............. 15. Is ch~? propert~w~ch~n 3q0 feet of a t~dal wetlahd? '*yes..' ...... No '~'~ '' ' . xZf yes, ~Bouchold Tolwn Trustees Permit may be required. · ...... PLOT DIAG~ Locate clearly and distinctly ~1 b'Uild~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from prope~y Hnes. Give street ~d block number or descfiptioh accord~g to deed, and show street nines and indicate whether inte~or or corner lot. ;TATE OF NEWd~RKJ~)~,~., A~,./~ f, i io'v ~ )~Name o'f'i~};~d~a~}~di~n~'d¢~;dc}~ .......... being duly sworn, deposes and says that he is the applicant is thb . (Contractor, agent, corporate officer, etc.) ............. said owner or owners, ~d is duly authorized to perfom or have perfomed the said work and to m~e and file this ~plication; that all statements contained ' this avvlic 'o nra trn~ t~ tho hoe* ~ __ at~_n ................. of his knowledge and belief; and that t~e ork will be perfomed in the m~ner set forth in the application filed therewith. ~om to before me t~s ~ ~ ........ .... of ;.&.,. {., 9..ff ~1~ ~uattC, ~a~ 0~ ~ ~, ..... / x ~. ~. ~. ~ .... ~ .............. N0. 487~05 Si natu · ' . ~alif[~ iA S~0{k ~ _~ff ~ ( g ~ of apphcant)