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Home My WebLink About22699-zFORM TOWN OF SOU'/HOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, N.Y. N~o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) z ~°'~ ....... ~~ ................................. ~'~ CountyTax Map No. 1000 Section ../~.,~.. ...........Block ...~/.~?, ............... Lot No..~....-~... ................... pursuant to application dated ........... ~/..~..... ......................... 19..../~....~..Z.., and approved by the Building inspector. ~ee $.,~.,~,~ ...... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ... Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SiTS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: . (Bui~ Infpcctor) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli~ :atton. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall be kept on the p~l~ia¢~.,a.vaLlable for inspection throughout the work e. No buildin~ ~h*~ ;o; o~cu~ied or used in whole or in part for any ~urpose whatever until a Certificate of Occupancy hall h-ave been graflfed by the, Buildffi~tlspector. AP?LICATIOyd[$~ HEKE~Y~MAiD.E to the Building Department for the issuance of a Building Permit pursuant to the luilding Zane Oi~igh~f,e 9,~',tl~e ~..Tb~n of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for .th~ ~onstm~tion, J.0f buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant '~greesrto co~ply with all applicable laws, ordinances,~de, ho, u, rd~eod~ and regulations, and to dmit author/zed,inspectors on .,p[em!ses and in building for necessaryqnsvectiov~. :,. ,, .... //~]- ~' ' .,"'g~ (Mailin~i'~ .~t~addre~K~f applicant) grate whether applicant is ow~, leS}aC, agent, archite~, e~ineer, general contractor, electrician, plumber or builder.. f ~li'~t is a ~or~ signature of duly authori .....i..~"."~r _..;~7 ...... · (Name a~'(;f corporate officer) Builder's License No.. ?..Ct.]. J.."...~. [ ......... Plumber's License No ........... .../~. ......... / Electrician's License No ..... X Other Trade's License No .... ../...~. ........... Location of land on which proposed work'will be done .................................................. ' 7 ................................... ~ ....... q gv.~ .........~,.~ ......... House Number Street County Tax Map No. 1000 Section .../..~..~ ......... Block .... /.(/ ........... Lot...2~. ,~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intend,cfi use and occuqp~ncv~''~f ~_ _ro,osedn constructton.' · a. Existing use and occupancy b. intended use and occupancy .......... "~" '~ .... J.i~! ~ ,-"~"' ,"' ~ :' ~'~,~'~r~' 3. Nature of work (check which applicable): New Building .......... Addition ...... .~.,...---,~rptio~ .......... Repair .............. RemoVal .............. Demolition ........... .,,~. O t h e r Wo rid .~..,g.,,~t/_.~ .... ...... ] _ ' k,~ J ~Descriptio~ (to be paid on filing this application) 5. !~ dwelling, nu.mber of dwelling u!nits . ./<w-.,, ......... Number of dwelling units on each floor .............. It garage, numoer of cars ...... ..... [ .....~. ....................................................... 6.' If business, commercial or mixed Ioccup~ncy. sl~ecffy nature and extent of each ty~? OLuse' .'J .'. ................. 7. Dimensions of existing structuresiifany~ Front ............... Re.ar ..... -: %-~'... Depth . . . Height ....... Numhof ,,r qlv,,~ .... ~ ............... Dimensions of same structure wit~ alte~a~t~VQ~ ~r additions: Front ~ ............. ~'~'~' .................. 8. Dimensions of entire new construgtion:_Fro~t~,. .... ~ ..... Rear ............... Depth ............... Height ............... Numb:er of Stories..',~ ./?. ............ 9. Size of lot' Front. ,-~z_x_ ................................ ............................. 1 ...... ~ ........ Name of Former Owner 11. Zone or use district in which ~remises ~'situated... ~ .............................. ............. 12. Does proposed construction violat n'a'n'c; o" lation: ................................ 13. Will lot be regraded ....... ~...<('. ................. Will excess"Ffll be removed from premises: Yes No 14. Name of Owner of premises ./~. .................. Address ..... ..x% ..... Phone No . . *If yes, Southold To~n Trustees Permit may be require~. ' .............. PLOT DIAGRAM .~ Locate clearly and distinctly all bhildings, property lines. Give street and block number or interior or corner lot. whether existing or ro osed and ind :~ ~ "' · ..... . P P , ~cate all s~t:b,a~,~hnensmns from uescnpuon according to deed, and show street nmh~ ~tnd ]~id~cate:whether APPROVED AS NOTED' NOTIFY BUILDING DEPARTMENT AT 785-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPEC'flON$: 1. FOUNDATION - TWO REOUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST SE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET' THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERI~ORS 20U .Si ........ · ! (Name of indi,d&~l signin~'~'o~'t~a'c'ti .......... being duly sworn, deposes and says that he is the applicant ~ove named. [e is the (C ) ......... -- i ontractor, agent, corporate officer, etc. f said owner or owners, and is duly au'thorized to perform or have performed the said work and to make and file this oplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed m the manner set forth ~n the application filed therewith. worn to before me ......... ~. '~,~..day of~_ ~../~. 1..., 19 .'~/. _29 ~mm~n txpires ~cember