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Home My WebLink About22960-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. Ne 22960 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Count/Tax Map No. 1000 Section ........... Z...~..,,,, Block ......... ..~.. ............ Lof No ..... ..~...'~ ......... pursuant ,o application dared .......... ~..-~....~.....~... ............ 19...~..~d approved by the Building Inspector. Fee $..~. Building In~ Rev. 5130180 ,FORM NO. 1 TOWN OF SOUTHOLD . ~ , ' ? BUILDING DEPARTMENT ~ TOWN HALL SOUTHOLD, N.Y. 1197'~1 ~ TEL.: 765-1802 Exa fined ~')_~g~fi~.:d fit-Z, 19~.j ') '' . · ......... BOARD OF HEALTII ........ 3 SETS OF PLANS ........ SURVEY ................. CALL . . . HAIL TO: Disapproved a/c .... . .................. ~. ..... : ..... '. , INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and sub~nitted to the Building Inspector, with sets of plans, accurat~ plot plan to scale. Fee according to schedule. b. Plot plan sho~ving'location of lot and of bulldogs on premises, relationship to adjoining premises or pubUc st?eet: or areas, and giv~g a dethled description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered by t~s application may not be commenced before issuance of Bugding Pemit. d. Upon approval of this application, the Building Inspector will i~sued a Bufld~g Pe~it to the appQcant. Such pe~fi~ shall be kept on the premises avaUable for inspection, throughout the work. e. No building shalI be occupied or used, in whole or in p~t for any purpose whatever u~til 'a'~e~ificate of O~cup~c; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildh~g Department for the issuance of a B~lding Pemit pursuant to the Building Zone Ordinance of tlze Town of Southold, Suffolk County';'Nd~ Y6rk, ~d ot'h'er fi'ppHeable Laws, Ord~ces or Regulations,. for the construction of bugdings, additions or alterations, or for removal or demolition, as here~ described. The appUcant a~rees to comply with all applicable laws, ordinances b~iLd~g bode 'h6fisin~o and regu atioh~ and to admit authorized mspecto~ on premises and m bmld~n~ for necessa~, ~n~ections. -'- (Signature of applicant, or name, if a corporati6n) , ..... : . (~ai!~g address d~ap~licant) - State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, sicnature of duly authorized officer. ~ ......... ~O REQUIRED (Hmn~ ~nd title o[ corporate o[~cer) ;] ~r,'~ ~OR POURED: ' ' ' CONCRETE BuildeFs'Licehse No .... '. ~ ....... .... ;..' ........ P~UMBING Plum'ber's License No ......................... BE cOMPLETE FOR C.0. ALL CONSTRUCTION SHA~ ME~ Electrician's LJccnse No ....................... THE REQUIREMEN~ OF 'STA~ ~CONS~UC~ON ,&. ENERGY Other Trade's License No ...................... CODES. N~ RES~NSIBLE FOR DESIGN OR CONS~U~ON ~ROR8 1. Location o~land on which proposed work will be done. House Number Street Hamlet ' (Name) ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: '3. Nature of work (check which apPlicable): New Building .......... Addition Alteration P, epair Removal .... Demolition : Other Wot 4. Estimated Cost ........ ! ..................... Fee 5 If d Iii numb old llingl its (to be paid on filing this application) · we ng, er we un ....... N mb f lfg e, b rof I Iii it hfloo · arag nume cars . ........ u ere cwo ngun soneac r ........... 6 Ifb i ..................... i 1 ixed pa Y Sl cify nat d .................................... . usness, commerca erin occu nc , >e urean extentof,each eo e .. 7 Di nsi ofexisti gst ! ifa F typ fus · me OhS n ructure , ny: rout ...... R ................... I! ight Nun!b of St i ' . ........ ear .............. Depth .... Di i f' t i!th It ti ...................................... d lift F ' · Dmens°ns° samestrucurew a era onsora t OhS rent ................. ear... ' epth .... '. ................ !..Height ... , . R ............... 8 Di sio fenti struction F ' · .... '..NumberofStories ....... ' ' · men ns o re new con : rent ......... ' Re ............. ...... ar ............... Depth ......... l-teight ............... Num her of Stories ...... . . 9. l~i2z;olfl~tu cFl[qOsnet ...i1~57U ..... P, ear ..~. '~"~5 ~ ..... Depth' ~:~.~ 1 0. r ' ' ' · ........ ' ......... amc of Forlner Owner ............................. 11. Zone or use districtqn which i ' prom,scs are situated .......... , 1~2. Does proposed constrt~ction violate any zoning law, ordinan'ce or ...................... '4,' 1'3. Will lot be regrh, ded~. ..... I,~Di regulation: .. ~223 ............... ....... .. Will excess fill be removed ......... "' .... 14. Name of Owner of premises i ............ from premises: Yes .... ................ Address ......... .......... Phone No ........... ' Name of Architect ........ , .. Nmne of Contractor ...... i. ' 'i ................ Address ................... Phone No ........ ' "~ ................ Address . .one~:j .... ' .... [5. Is this property within 3 0 feet of a tidal wetland. *Yes ........ No..~.. ...... ' ..... . . · · '~ ............... Ph o .......... ~I£ yes~ Soutbold T~wn 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 block ngmber or description according to deed, and show street names and indicate whether interi,or or corner lot. rATE OF NEW YORK, ' OUNTy OF. ..... :. ' ' ~' '~/' . ....... being duly sworn, deposes and says that he is the applicant - .(NmDe,ofindividual Sign rig' dpotract) , ., 'is the . .~ ....... r ' '" 4 ....... ' ....... ' (Contractor, agent, corporate officer, etc.) .......... said owner or owners ~d is du y au~lior~zed to perform or have perfo~ed the said work and to make and file this plication; that al!,g,tatements containedj in this applicat on are true to the best of bis knowledge and belief; and that the ,om to before )rk will be perfony~ed in the manner Eot, , , , , .. , , . , · tau 1}9 b[~c , ~ u~"o,~tat~ofN~y~ (Signature of applicant) ~o. 4822563, Suffolk Cou~ Term Expires Decem~r C L/)