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HomeMy WebLinkAbout22814-zFORM TOWN OF $OUTHOLD BU~LDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT N£ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ~~ ....... ,9...~..~..... ond opproved by,he pursuant to application dated ............ ~..~...~~ Building Inspector. Fee~...~.~ .......... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BI,'~ m;. ~ DEPARTMENT, 8OUTHOLD, N,Y. 1197~ TEL.: 765.1802 .... ...... ...... Disappr~ea~ .............................. ~..:. ............................. .. ~LI~TI~ FOR BUILDING PERMIT INSTRUCTIONS B~)ARD OF HEALTH ........ 3 SETS OF PLANS ........ c.z~ ........ ::.: '2':" SEPTIC FORH ...... hDrzpy, CALL . . · · ..... HAIL TO: Date ' · 19 : a. This pphcahon must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of tJuildings on premises, relationship to adjoining premises or public st~'eet or areas, and giving a detailed descriptioh of layout of property muJt be drawn on the diagram which is part of this appL 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 Ins.pictor v~ill igsued a Building Permit to the applicant. Such permi 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 Occupanc' shall have been granted ~,y the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building DepartmeJt for the issuance of a Building Permit pursuant to th 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, ~i~4ing code, housing code~,and regulation), and t( admit authorized inspectors on premises and in building for necessary [p~l}tions. / ~j .,// .! / · ". . ' .... .... ...... -- ' ~ ... . . · (~ ~qature ~f applicant, or name, if h corp¢~/ation) .. · ...,. . ..,.7.o((,...,s.~r/.,~.9.¢.f...&. c~..~ .~. ~.e: ,,, . ' , ', . , . ' . (Mailing ~ddress of applicant) State whether applicant i~ owner, lessee, 'agent, architect, engineer, generM '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 authori:~ed officer. · (Name a~'d; title of corpm:ate officer) Builder's License No ................. Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... 1995 1. Location of land on which proposed work will be ~lone House Number Street Hamlet Couhty Tax Map No. l'000Section .........,..'Ox~/pO.....' Block ' ..(~.,.~..~.O.... ' Lot...~.//)...O~..~,..O~.. Subdivision ' Filed Map No.' ........ . ............................. · ............. Lot ............... (Name) 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: © . xisting use and occupancy .............. ......... b. Intended use And occupancy ' '3. Nature of work (check whichiapplicable): New Building .......... Addition .......... Alterati__on .......... Repair .............. Removal ............. Demolition .., .... ........ Other Work..?Y...~,~f'/.~t~' ..... .... ..,,0 (Description) 4. Estimated Cos o ..... Fee .................................... (to be paid on filing this application) 5, If dwelling, number of dwelling units', ............. ,, Number of' dwelling units on each floor ................ · If garage, number of cars ............. ' , . . .. 6 If bumn.ess commercml or m~.,~ed occupancy ' ' · ' specif2q~ltgre,,and extent of eacb,~pe of use 7 D~mensmnsofexistingstruatu'res if any:Front .~..~.f~......2~ Rear ¢/.~rO0. ............. 7 ..... Height Nt~m ............... ~er of Stories Depth ...... Dimensions of shine structure ivith alterations or additions: Front : ~D.epth ..... :;, ............. i .H .................. Rear ........... · .. eight ........... . ........ ?' . . Number of Stories .......... '.:.~.ii ..... u~mensmns or entire new cons, tructmn: Front .............. ; Rear .......... Depth ....... ' ' ' ' 9..Height ... i .......... Nu'mber of Stories ...' ........................................... Size of lot: Front ......... 'i... Boo.- ' ,, ' .' ' "' ' ' ' 10. no.,,,,~-¢,,,,,u,~ ~-o ?. ,n,,,gn~,,.,;'' '/t~9'rJ .......................... ~epti~ ..................... .... ,.,-*~*,,.a~;..., .t., .,~. ~.,F.v.~.,.....t.17/_,.I ...... ', Name of Former Owner ........... . ............ 11. Zone or use district in which premises are situated .............. ' ........................ ' ' ' ' 12. Does proposed construction violate any zoning law. ordinar~ i '..' .... ce or regulation: ,"...' ....... '. ....... 13. Will 16t be regraded · . ....... ' ,,,.. ..... ' , ~ '. ' ...... ..... ' '. ',,~_' 2 ' 5:'1 ........ ~m excess Illl De rerBovea ~rom premises: Yes ~o 14. 2amc o[ .uw,n,e.r o~. premises .~f~,(t).l?~(~.~.; ...... Address ~.Q~. rY,~,,~¢¢ ,?f',,,. Phone No, ~tame Ol Arcmrecr .... i ' Addros~ ~ ' ~h,, x~ "~ ' Name of Contractor ........ i .................. Address ............. , ...... Phone No .............. 15.' Ig this property w±thfn~300 feet of a tidal Wetland? *Yes ........ bio ......... · If yes,'Southold!Town Trustees Permit may..be required. ' ' PLOT DIAGRAM : Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. NOTIFY BUILDING D~ . ?.65~802 9 AM ~ 4~ FOLLQ~NG INSPE~ONS: 1. FOUNDATION .. ~0 REQUIRED FOR POURED 2~ ~OUGH. F~MING ~ P~MBING 3~ 4~ FINAL CON~U~ON MU~ BE COMPL~E ~R C.O. ALL CONSTRU~ON THE RE~UI~E~ OF ~E N.~ ~TATE CONS~U~ON CODES. N~ RES~NSIB~ FOR D~SIGN OR CON8~U~ON STATE 0 F NEW/~Y,Q l~.t5-~, (Nam~ of PMdividual signi~g~contract) 1bore named. I (Contractor, agent, corborate officer, etc.) )f said o~ner or owners, ~d is duly~ authorized to perform or have perfo~ed the said work and to m~e and file this tpplication; that all statements contaihed ~ tt~is application are t'rue tO the best of his ~owledge and belief; and that the ~ork will be perfo~ed in the m~ner ~et forth in the application filed therewith. ;worn to before me this being duly sworn, depose5 and says that he is the applicant