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Home My WebLink About22506-zFORM NO.B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ....... 22506 Z ....................................................... .,~...~./...~X,...~ .......... /...W..,..%.., ....................................... co,~n~oxMap,~o. ,000 sec, on ....... ,2......~....... B,ook ...... .,~ .............. Lo,,~o...Z~.'....?'.. ........ pursuant to application dated ................. ~...~.....~,..../....~.. ........ 19...~...,~......, ond approved by the Building Inspector. Fee*~...~ ...... Rev. 6/30/80 Building Inspecti~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ................... .(~ ............ · // . (Building Inspector) / ~,' ,fTICATION~/, FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF 'PLANS .......... SURV£Y ................... ClIECK .................... SEPTIC EORH .............. CALL .... HAIL TO: a. Ttfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ets 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll- :ation. e. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 Occupancy .hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to .dmit authorized inspectors on premises and in building for necess~spectior~s. .:, tc. : ....... -- (Signature ,of applicant, or name, if a corpc~ion) (Mailin~ addresfi7o f applicant) ~tate whether applicant~owner, lessee, age__architect, engineer,~contract~, electrician, plumber or builder. ................ :. .............. .-. ....................... qame of owner of premises ..~... ~_~ fapplicant is a corporation, '~nature of/'' - duly authorized o(f};~Y, the t~/r°ll °r latest dyed) ''' (Name and title of corporate officer) Builder's License No .... ' Plumber's License No ..... ~.. ~. .............. Electrician's License No. ,/f-/"g~ Other Trade s Lmense No .................... Location of land on which proposed work will be done .................................................. .........p. .... sT-- .... . .. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..~. .......... Block ~ Lot...//~..~ Subdivision ..................................... Filed Map N° ...... : ........ Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~'..Y~ ....... . ............... ,. ........ .... b. Intended use and occupancy ................... .~. ~., ............ ; ...... .... 3. Nature of work (check which applicable): New Building .......... Addition .... ~_~Ah'v~tion .......... Repair ..... Removal .............. Demohtlon ............. ~ Work~..~..~ . . . I ~ ~ (Description) 4. Estimated Cost ,~..~_.~..O. ,. ~ F (to be paid on filing this application) 5. If dwelling, number of dwelling ulnits ............... Number of dwelling units on each floor ..... ........... If garage number of cars 6 If business commercial or m]xedioccupancy ............................................... · , , specify nature and extent of each type of use ..................... 7. Dimensions of existing structurest if any: Front Rear Depth Height Number of Stories ............................................ Dimensions of same structure with alterations or additions: Front ........... ................. Rear ............... Depth ..................... !; Height Number of Stories 8 Dimensions of entire new eonstrulction: ............................................ · Front Rear Depth Height .... Num ' ' ........... her of Stones ......... 9. Size oflot' Front ' ' ................... ............ I .......... Rear ..................... 10. Date of Purchase i · · · ' .... Name of Former Owner ............ 1 1. Zone or use district in which prerfiises are situated ..................... 12. Does proposgd constructlpn violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ' ' -~-~-.~ ..... Will ...... ....... J~ ......... ~ · · · excess nu oe removea trom premises: Yes , No 14. ame ?w er ofpremises Address Crone No r~ame otArcnitect · -~ _ ...~(-C'~ .~,.~, Address p~ -' ' ........... N~ame,°.fC°ntract°r '/'~'"'/.~.~ ..... ~: ....... Address,~C~.?f ~',,l:'~. ~.~..¢~,.~"¢. Phone No. ~...~.~'~./.',//..~.. 15. -s tk~is property within 300 feet o~ a tidal wetland? *Y~s ...... '..'/~ ........ '. ' ..... · If yes, Southold To~n T~ustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all, bhildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give treet and block number or descnptmn according to deed, and show street names and indicate whether interior or corner lot. \ -- 'APPROVED AS NOTED NOTIFY BUILDING O~ 765~1802 ~ AM TO 4 I~FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE p ' 2, ROUGH ~ FRAMING & LUMBIN,G 3. INSULATION ' 4, FINAL CONSTRUCT[ON MU~T 8E .OMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N..~ SLATE CONSTRUCTION & ENERGy CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR~ ;TATE OF NEW ~'~ORrg~ **. o o :o~y OF... ?. 9.~..~X~. ..... °'° ' ' i ' ~' ~' ~'(~a'~m'~'~ ' ~' '~'~' '~' ....................... being duly sworn, deposes and says that he is the applicant (N me of individual signing ~ontract) hove named. (Contractor, agent, corporate officer, etc.) [' said owner or owners, and is duly auihorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the m..a~ner set [forth in the application filed therewith. worn to before me this otary Public ...... · · · un ROBERT,, sc0 ,, / T~2g~8~g,~au~fl~. ~ k~,gnamre of applicant)