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HomeMy WebLinkAbout22550-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAM. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUT~J2.1~ED) 22sso z Do,e ......... p....../..~ .................. ~9~ .................................................... ~.,~._~..../..:~.~.c~ ............ ~...v...:.~..: .................. CounlyTaxMapNo. 1000 Sectlon.,.Z,~,.,...~... ...... Block .......... ,~. ........... LotNo. Z/,/,....~ ....... pursuant to application dated .......... ~-')~..,~,..~. ,~. ......... 19...?... ~... and approved by the Building Inspector. Rev. 6/30/80 BLDG. DEP'[ · TOWN OF SOUTHOI..D a, i . . . //:.z.~/ ....... , Iv.. sapproved a/c ..................................... APPLIC,~TI/ON FOR BU LD NG PERMIT ' INSTRUCTIONS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC PORK! .............. tlOTI FY; CALL ................... MAIL TO: r/. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s of plans, accurate plot plan to scale. Fee according to schedule· 1b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tlie Building Inspector will ispued a Building Permit to the applicant. Such permit fll be kept on the premises available for inspection througliout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy dl 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 tiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable LawsiOr. dinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. --- (Signaturd of applicant, or name, if a corporation) ·..¢:~: .¥.o~:..Lq. 9. :..¢.~..~.~: .q. ~.N....t.(. 5.~..8 · (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............~,3.?.c-~..^~ ..................................................................... # lme of owner of pre,nises. ....... 'P .~.-i. . ........~q"- · I~-.'. ...~7.r~..~3..~.~..~.~. ·R; .G.' .eS.' ........................... (as on the tax roll or latest deed) ture of duly authorized officer. ...... Builder's License No...~.-.'.~... ?. .~. .~. 5. .(q'. ....... Plumber's License No ......................... Electric. ian's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be' done .................................................. c3~15- . : ........ House Number Street Hamlet County Tax Map No. 1000 Section [ Block Lot.. .' ........... Subdivision ~. U2.. Filed Map No ..... Lot (Name)~ 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 .......... Repair Remov~l Demolition Other Work ~2. ~'T~)i©~ (Description) 4 Estimated Cost ' Fee ~ (t g thi ppli ) , o be paid on illin s a cation !it bJ'/~,. 5. If dwelling, nmnber of dwelling un s ............... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or m~xed occupancy, specify gatujie and extent of each type of use ...... '. .: ........ 7. D~menslons of existing structures, ~f any: Front...[.M..: .P.~ ...... Rear .............. Depth ............... Height. . ...............NumbCr~ of Stories ......................................................... Dtmensmns of same structure withlalterations or additions: Front ................. Rear ........ , ......... Depth ...................... e~ght .... r ...... .., .......t · · Nmnber of Stories ............... L. ...... 8. Dimensions of entire new construciinn:~t ..... ~. . ..... · [-e~ ~Rear ............. Devth ......... Height ............... Numbe of Stories ................ t "' '" ....................... 9. Size of lot: Front ............ i ......... Rear .... -/ .~. Depth 10. Date of Purchase ..... i . l~ame qf Former Owner 1 I. Zone or use district in which premises are situated .~..-q...~ t?-.-..~...~ 12. Does proposed construction violat~ any zoning law dinan egulation ) or ce or r : ....... · .......... . ......... 12. Will lot be regraded ........... i ................ Will excess fill be removed from premises: Yes No [4. Name of Owner of remises?...ff,.~'c,u'(-e,~oo~'c~x 5~/M_~"b-'o.~ Cove, q - Z ... P ' ' 'i ......... '~u ....Address ~.~ ............... .~one No. ¢...~...--~..~. Name of Architect ............ i ............... Address ................... Phone No ................ Name of Contractor .~.~..~' .~...~5~..i. ! .~..C.. ........ Addres~l?. 7.~./.tpp...¢~.. ,.~.~ .~.,... Phone No..7.~..4.-:7.4:..7.~ .'.. 5. Is t:h±s properly w:t(:hin 300 fee(: o£ a (:tdal we(:land? ~Ye~5 ........ No ......... ~I£ yes, Sout:hoid To~n Trust:ecs Perm±(: may be requ±red. , ."~ ! PLOT DIAGRAM Locate clearly and distinctly all btlildings, whether existing or proposed, and, indicate all set-back dimensions from ~roperty lines. Give street m~d block nu~nber or description according to deed, and show street names and indicate whether nterior or corner lot. ' APPROVED AS NOTED .* Y BUILDING D 765-1802 9 AM ~ ~~ FOLLOWING I~SPE~oNs: 1. FOUNDATION . ~0 REOUIRED FOR POURED CO~CRETE 2. ROUGH . FRAMING & PLUMBING 3. ~NSU~TION 4, FINAL . CONST~U~ION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION 8HALL ME~ THE REOUIREME~ OF ~E N,~ 'STATE CONSTRUC~ON & ENERGy CODES. N~ RERPONRIB~ FOR DESIGN OR CON~U~ON ~ROR8 (Name of individual signing Contract) eve named. .... being duly sworn, deposes and says that he is the applicant ~is the ................... }...{~.. ,~aid owner or owners, and is duly audlorizea~Fo~perform or have performed the said work and to make and file this plicatlon; that all statements contalnedi in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner set iforth m the application filed therewith. ' . ,om to before me thi~ )tary Public, · · Cou No. 4879606 Oulllfled in Suffdk County ~/~L- ' ~ m~,n ppllcano ~ml~lon ~lrea Decem~r $,19~