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Home My WebLink About22776-zFORM NO.$ TOWN OF SOUTHOLD BUtt, DING DEPARIMENT TOWN HALL SOUTHOLD, N.Y. N9 22776 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) CounlyTax Map No. 1000 Seotlon....../..,,..~../... .......Block ....... ...~.,...~.... LotNo ...... ~....~.. .............. pursuant to application dated .................................................. 19 , and approved by the Building Inspector. .... lng Inspector Rev, 6/30/80 ~ 6.~ DEP'f, OF \ ',.! ,.' t.~ SER~410ES ELEVA ?'IONS ARE REF~RENCE'D TO AN ~SSUMED D~ TUM. D EPARTtC~ENT The ~ewage disposal and water supply ~cilities for this location have be~n insured by this ~pa~meflt ~nd/or satisf~r of Wastewater gO4P gO,Ap The /oce//ons of we/Is end ce~'spoo/s ~ ~ shown hereon ore from field obserwzt/oos V~~'°~ end or from dq~l~_ obtained from others ........................... ;. TOWN HALL ~ ~:.~.~S. r~'~. SOUTHOLD, N.Y. 11971 ....... '": ........... ~'~ ~ TEL.: 765-1802 ....... Disapproved a/c .... .. ./(Buli~g Inspector) ' APPLICATION FOR BUILDING'PERMIT BOARD OF HEALTH ........ 3 SETS OF PLANS ........ SURVEY ................. CIIECK t;OTl FY; CALL ...... · .... HAIL TO: INSTRUCTIONS Tiffs application must be completely filled in by typewriter or in ink-and subm{tted to the Bui!ding Inspector, wi.th 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 description of layout of property must be drawn on the diagram which is part of this appk cation. ,. c. ' The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Braiding Inspector wffl Issued a Building Permit to the applicant. Such perm/ shall be kept on the premises available for inspect/on throughout the work. ' e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc. shall have been granted ~,y the Building Inspector· APPLICATION IS HEREBY MADE to the Building Departmerit for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southi)ld, .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 taws, ordinance~r~building code, housing code, and regulations and admit authorized inspectors on premises and in building for necesc~se, ctions' 2--, ~ ., ' '- ' ....... (Signature of applicant, ~ name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. Name of owner of premises .... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer· (Name and title of corporate officer) '" ' ' Builder' Lice se N ' S n O ............ Plumber's License No ....... . ........ . .......... E1 '' ' L'ec No trlcmn s zcense . .. ........... Other Trade's License No..'~..~.~/.~..~.- ~i~' ./~/5~q ~f'~-.~ ~L~lr~ ~b~,~O[O]9{.-'-J CO' 1. Location of land on which proposed work will be done· g. . .S:V c_- .........' ......................................... House umber Street Hamlet ou'.ty C Tax Map No. 1000 Section ... :l ' · ........ Block Lot. Subdivision ........ . ............................ '. Filed Map No ........ Lot (Name) ...................... 2. Stat~ ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................. -'.., .- ................... b Intended use and occupancy " ' ' · 3. Nature of work (check which applicable) New Build ng. ~ ........ Addition .......... Alteratio. q_a ....~ .,,,~ .~., Repair .............. ' Removal ............. Demolition .... Otk~:,W.0rk...['7~..0..C~..~.~') ~ ..... (Description) 4. Estimated Cost .... ! (to be paid on filing this application) 5. If dwelling, number of dwellingI units' ....., ..., .... .N.u.m.b:r o:f dwelling units on each floor If garage number of cars :'. ' ............... 6 If business commercial or mixeld occupancy specify nature and eXtent of each · , ' . , , type of use 7 ..... if any: Front Rear .............. ' ..... · D~mensmns o! existing structures , Height Numl~er of Stories ..............................,, Depth .............. : Dunensmns of same structure W~th alterations or addmons: Front ......... Rear ............. ...... t ' ' ln-elgllt ........... ' ........ ,., Number of Stories .......... '. '.. i ...... 8. Dimensions of entire new constm, etlon: Front ...... ] · · .; Kear ............... Depth ....... ~ ..... ,Height ... i ........... Number of Stories ...................... ' ,. ~'"q 1. Zone or use district in which premises are situated ...... ' / ' ' .' 12. Does proposed construction wolate any zomng law, ordinance or regulation: .... ,~. ~ ........... ~ ............. 13. Will 16t be regraded ...... . I ' ·. ~ ................... Will excess fill be removed, from premises: Yes,~ ,_ 14. Name of Owner of premises .~.LqDq .(O .~,~f3.13l.~, . Address ~O'.{-Jc>/'.'{gr~3. Jc~.e~..[~.~Phone No..c~?.~:'.,~.¢~... Name of Architect ......... i ............ J'.. Address ........... . ....... 15. I.s thie property within }00 feet of a tidal 'wetland? *Yes ........ No...~. .... · If yes,'Southold Town Trustees Permit may, be required. PLOT DIAGRAM : Locate clearly and distinctly all buildings '~heth~r existing or proposed, and. indicate all set-back dimensions Ikom property lines. Give street and block humber or descriptiofi according to deed, and show street names and indicate Whether b~terior or corner lot. STATE OFNI~I-~OR~.~"3 fl/'// '~4 S 7?UNT. Y OF, (Name of individual signing contract) above named. DAT~: ~ ....... ~,R # ~ FEE: ~ , BY: ..... NOTI~ DUlL,DING DEPARTMENT AT ~-(~54802 9.AM TO 4 PM FOR THE FOLLOWING ~NSPECTIONS: % FOUNDATION -' '~OREQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3, INSU4~TION 4. FINAL CONSTRUCTION MUST BE COMPLETE FO~ C.O. ALL CONSTRUCTION SHALL ME~' TME EEQUIREMENTS OF THE N,Y. STATE CONSTRUCTION &' ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ........ being duly sworn, depose.s and says that he is the applicant :It is the (Contractor, agent , cor'porate officer , etc. ) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contaihed in this'application are true to the best of his knowledge and belief; and that the ~'ork will' be performed in the manner ~et forth in the application filed therewith. ;worn to before me this i .,utateofNe York . ' (Signature';[~pli~int) Oualffiod ia Suffo k Cou0~ ~ommlss,on Expires Oecembo~ 8, 19 ~