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Home My WebLink About22682-zFOBM NG.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. Ne 22682 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,~.~ ....... ~.~....,~.~ ............................. ..~.~ ........ ~.~ ......... ~..¢..:....../..~.~./..¢ , ~~ ........ ~ .......... ~~ ~ ~ ........................ , ......................... ,,~', CounlyZaxMap No. 1000 Section ...../../.~.. ........... Block ...... ~.'~,, ........... LotNo ......... ~ .......... pursuant to application dated ..~./~..,~.......~....~.. ................ 19......~..~, and approved bythe Building Inspector. Fee $.,~,,, .~,;..~ ..... Rev. 6/30/80 FORM NO, 1 ~OWN OF SOUTHOLD ~UILDING DEPARTM ~NT; TOWN HALL Disapproved a/c ' ................................'"'". , APPLICATION FOR BUILDING'PERMIT 3 SETS OF PLANS ....... SURVEY CI1ECK ................. SEPTIC FORH ........... CALL MAIL TO: INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with NOTIFY 8UILOIN() OEPARTMENT AT 76521802 9 AM TO 4 PM FOIl FOLLOWING INSPECTIO~S: 1, FOUNDATION - TWO REQUU?ED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION RE COMPLETE FOR C,O. ALL CONSTRUCTION SHALL M~ET THE REQUIREMENTS OF. THE N.Y. STATE- CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1. L.ocat.~ion of land on which proposed work will be'do, ll~ ............................................... House Number Street Hamlet ' 11.3 :3 County Tax Map No. 1000 Section ....... ' ........... Block ........... '... Lot. ~;~ ........... St bd vis on,,; .................. ...' .......... Filed Map No, Lot (Name) 2; Stat~ existing, use and occupancy. O~l~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ' ........ b. Intended use ~nd occupancy ...'.'~.. ""'"~' · .~' .......... · ................ . Plumber's License No Electrician License No ' Other Trade's License No ...................... ·. (Name and title of corporate officer) Builder's License No ......................... If applicant is a corporation, signature of duly authoriv2ed officer. sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of l~uildings on premises, relationship to adjoining premises or public st?eet or areas, and giving a detailed descriptioh of layout of property mu~t be drawn on the diagram which is part of this apph 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 Budding Permit to the applicant. Such perlmi 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 Occupant, shall have been. granted l?y the Buildivg Inspector. · APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tht Building Zone Ordinance of the Town of South61d, Suffolk County, New York, and other applicable Laws, Ordinances o: Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t¢ admit authorized inspectors on premises and in ~ ~/.., . building for necessary insp . ' -- ' ' 7_ _ (Si°nature of alk6licant, or name~ if a corporation) ,'~/,'t,/ 3/~,,c"5, '-'/- (Mailing address of applicant) State whether applicant ~s owner, Iessee,'agent, a it , g' e , general contractbr, 6I~fizi~.plumber or builder. N~me of.owner of premises ...... .~ ....... (as on the tax roll or · 3. Nature of work (check wi)ich alpplicable): New Bu'fldin'g .: ....... : ,/,ddition .......... Alteration,,,... }. !,.. Repair .............. Remova1 . ·. 0 ........ Demolition .; ........ Other Work...-~'~'A~¢../.~. ' . .... (Descrip/~i 4. Estimated Cost . . . ~.,.O..o, Fee ' (to be paid on filing this application) 5. If dwelling, number o-f dwelling units ........ ', Number 6f dwelling units on each floor ...... · If garage, number of cars ~ .... ' · ' .......... · It ous ness, icommercial or mixed occupancy specify nature and extent of ........... ' .... 7 D' · · . · ' . , ' ,each type of use · ~menmons o! emshng structur¢s if any: Front ............ ~ ..... Height ' Number of Stories ' Depth ' ............... Rear .... ........................... : Dimensionsi of shme structure with alterations ' ' or add,hens: Front Depth ' I .................. Rear Height , Number fStones ................ · Dimensionslof entire new construction: Front .................... ' Rear Depth Height : Nuniber of Stories ............... ' ........................... Front . . ...... ' of PurChase ......... , q ............ Rear ....................... Depth 10. Date ~ .................... ,, , .................... ' ....... Name of Former Owner I1. z, ' 'hp~ ................ one or uselalStrlct in WhlC r mists are SltUated.. ...... ' ....... '. ...... J2. Does proposed construction violate any zoning, I~,~ ~---~--"~-' ' ': '.' '. .......... '.' .......................... 13. Will be regraded ....... : .I ................ Will excess fill be removed from premises: Yes No 14. Name of Owner o remises ...~ ........ , ........ Address .. ~ ....... . ......... Phone No. . . . Name of ArChitect , ' ......... ~,,~ Address ........... ........ Phone No .... , · ·., ........... . Name of Contractor . ~ ..~ ·. Address .Z.O,~..~/. ,-~.~.-c~ . Phone No. ~./4 15. Is this p. operty within ~00 feet of a tidal 'wetland? *Yes ........ No..z~.. ' ........ ~Ifl yes,'Southold ~ow.n Trustees Permit may be required. '''' .... i' 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 descnptmn according to deed, and show interior or corner!lot. treet names and re&cate whether STATE OF NEg( YORK~ .., ,. cou__,i, rr.¥ OF .,V..ek?.Y.o.&r;...: .. ...... .... (Name,of individual signinl contract) ~bove named· ~Ie is the~....k~...'~. ~ ........... >f said owner or owners, and is duly uthorlzed to perform or have performed the said work and to make and file this ~pplicatlon; that all statements contained in thlsupplication are /rue to the best of his knowledge and belief; and that the york wi/l' be performed in the manner s!t forth in the application filed therewith. ' ;worn to before me this Notary Public, Sim.': ~,'~ New Yortt . , ,~~, NO. Oldie 47D,~:~4~ I ' Qualified In Ouoonu l;ou/~¥/ Commission Expires -0~ r' ..... being duly sworn, depose.s and says that he is the applicant (Contractor .................................... ' .............. , agent, corporate officer, etc.) , (Signature of applicant).