The URL can be used to link to this page

Home My WebLink About23109-zFORM NO.3 TOWN OF BOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..~.,./ -- ' Y~/~ 1 ........... uaTe .............................................................. N~° 23109 Z CounlyTax Map No. 1000 Seation ......... ./..~....,~....... Bloak~ //' .............. . ..~........ Lot No. .....-~....../. ................. pursuant to appllaatlon dated ...................... (~.~...~.........~.....~.. ...... 19....~...~. ..... and approved bythe Building Inspector. Rev. 6/30/80 t OCT 26 1995 , i','! TOWN HALL - L ................ ] ./ $OUTHOLD, N.Y. 11971 . , [tLU~. I] ;.'t. '. /, TEL.: 765-1802 Disapproved a/c ..................................... // A~IC~ION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORMNO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK . - - NOTIFY CALL ................ MAIL TO: Date ................... 19... INSTRUCTIONS a. This application must be completely ill/ed in by typewriter or in ink and submitted to the Building Idspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspect/on throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building'Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for, the construction of buildings, additions or alterations, or$or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~m,, code h,,usino codo/h'hd re,relations and to admitauthon,'zea, inspectors on premises and in building for necessary in~'i~.c~_i~ecti~ns. 7' ~'~" ° //' ' ..., ,. ':, . ... y/~i'g~;;t~r'e';¢;l~l~li;a~;;;~e',ifa corpora"'-""""" ;io'n') .... (Mailing address of applicant) State whet er~applicant ,is:owner; hssee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~:. . . ...,,' ,,~ *:'t,.; . .'. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. " (Name ;~ }itle of c;~o~;i ;~ir) . '" ALL CO~TRACTOR'S MUST~B~ ~UFFOLK COUNTY LICENSED Builder s License No...p,~..t¢.~ .C(~. ............ Plumber's License No.' Electrician's License No ....................... Other Trade's License No ...................... I Location of land on which proposed work wilt be done: House Number Street . Hamlet County Tax Map No. 1000 Section .//]~. Block ¢ Lot. ~./ Subdivision .................................. -... Filed Map No ............... Lot ............... (Name) 2. Sta[~ existing USe and occupancy of premises and intended use and ~ccupancy of pro'posed construction: a. Existing use and occupancy b. Intended use and occupancy .................... 3. Nature of work (check which apphcable): New Buildin~ . . ' ..... Addition ....... ~,,'~tioh . ;. . . Repair ........... .:.. Reraoval~ .............. .... Demolition ......... ~ . . l'fthe,' Wnrl/') ~~r'Jc..~'~ .... .,..... · c ..... 4. Estimated Cost ...... ,,! ..................... ..... Fee........... ..... ..'.t; ............ ...... i " (to be paid on filing this application) 5. If dwelling, number of dwellingI units ............... Number of dwelling units on each floor ........ '. ....... If garage number of cars i ~. If business, commercial or mixe:d occupancy, specify nature and extent of each t.ype of use .................. · Dimensions of existing structures, if any: Front ........ i ...... Rear .... De,~t'h' Height...............NumberofStories.."... i i ................... i '' Dimensions'of same structure x~ith alterations or additions: Front ........... Rear ..... ; ..... pth ................... i ' ' He:ght ...................... Number of Stories ....... 8. tnmenmons of entire new constrUction: Front. ....' ..... Rear ....... Donth Height .............. Nunlber of Stories . ' ......... ~ ................. S~ze of lot Front , ~ Da u ~ P ................ 10. te ofP rchase , . Nam ~Fo ........................ eoI rmeruwner ............. . .............. 11. Zone or use district in ' ~ ' wMch premises are situated ................................................. ~... 12. Does proposed construction viollate any zoning law, ordinance or regulation: . , 13. Will lot be regraded .......... ' ' ', ........................ :' · · ..... ~ ............... Will excess I111 oe removeu from premises: Yes No 14 Name of Owner ofpremis% ~ Address Phone No · Name of Architect .... i .................................................... ........................... Address ................... Phone No ................ Name of Contractor ......... ] ................. Address .... : .............. Phone No .............. 15. Is this, property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ..... .o '' · If yes, Southold Town Truitees Permit maybe required. .... PLOT DIAGRAM Locate clearly and .distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from oroperty lines. ~ve street and block gumber or description according to deed, and show street names and indicate whether interior or comer lot. t.4~3t<' F~Mc-er ~ APPROVED A~ NOTED 76B-1802 9 AM TO 4~I~W'lrOR THE FOLLOWING INSPECTIONSI 1. FOUNDATION - ~0 REQUIRED FOR POURED CONCR~ 2. RO~H - FRAMING 8 PLUMBING 3. INSIJ~T;ON 4. FINAL - CONSTRUCTION MUST BE COMPL~ FOR C.O. ALL CONSTRUCTION 8HALL ME~ THE REQUIREMENT8 OF THE N.Y. STATE CONSTRU~ION · ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR ~NS~U~ON ERRO~ (Name of {ndividual signin¢ confract) ........ being duly sworn, deposes and says that he is the applicant ~bove named. ' (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 :pplication: that ail statements contain~ed N this application are true to the best of his knowledge and belief; and that the .york wHl be perfomed in the m~ner s~t forth in the application filed therewith· ;worn to before :ne thisr ] .- .day of.. ..... ..... 19.(.~ ~ NO. ~7950 , . ~/ ' '~ ........ QMtllled In Sufl~k Counw ~/t* · ' ~mi~n ~k" O=~~r8'19=~ ~;//