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HomeMy WebLinkAbout22485-zFO~M NO.$ ToWN OF SOUTHOLD BUtt/)tNG DEPARIMENT TOWN HAU. SOUTHOLD, N,Y. Ne 22485 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,/~¢ ~~~ ~~:.~ .... ................ CountyTaxMapNo. 1000 Section //-'~3 Block ~ LotNo ...... ..~..... .............. pursuant to applloatlon dated .......... ~....~..../..~. ................. 19...~.....~...., and approved bythe Building Inspector. Rev. 6/30/80 Building Inspector/ , ,~- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ SOUTHOLD, N.Y. 11971 : ..... ...... t 1 ~' -- TEL 765 1802 B DG DEP' ~/~ ,; ' .,'!( ,I · ~_' Examined . :~.~:,~ ~ ...... , 191../~, ' ~' ~pproved .......... ! ~ rmzt No.,., ....... Disapproved a/c .................................. . ffLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANs .......... SURVEY ................... CIIECK ........ HAIL Date .................. ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the ]3uilding 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 appli- ation. , c. 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 gall 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 .mil 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 uilding 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 ::imit authorized inspectors on premises and in building for necessary insp~ctions~'/O~(gn~ ~/;' n -" '" i ;i .... . y.¢. .... (Mailing address of applicant) ,rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) ,'" applicant is a corporation, signature of duly authorized officer, (Name and title of corporate officer) Builder's License No .... ~.0q .Mr?. ............... Plumber's License No ........ : ................ Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done...~..~.q..b~.../~.o...,5~...zfd4ff...~..,q2d.~ ......................... House Number Street Hamlet County Tax Map No. 1000 Section .... /.~..-~. .......... Block ...... ~.. ........... Lot ....~. .............. Subdivision ..................................... Filed Map No ............... LOt ............... (Name) State existing use and occupancy of premises aud intended use and occnpancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which~pplicable): New Building .......... Addition . ~/. ...... '. Alteration .......... Repair .............. Remova1 .............. Demolition .............. Other'Work ..... SC on 4. Estimated Cost .... '" i ..................... Fee ....................... I (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 ... i ....... ' ............ ;'2;', .......................................... 6. If buszness, commercial or mixied occupa c , natur I extent of each type of use ............... 7. Dimensions of existing structures, ffany: Front ............... Rear .............. Depth .......... Height ............... Nuimber of Stories ........................................................ Dimensions of same structure ,frith alterations or additions: Front ' Rear Depth i Height .................................. ................... : ......................... Number of Stories 8 Dimensions of entire new construction: Front ...................... · Rear Depth ight {nb f Sto. ri~ He ............... Nu er o s ........................................................ 9. Size of lot: Front .......... 1 .......... Rear ..................... Depth .......... 10. Date of Purchase .... Name 9f Former Owner ............ ' ....... 11. Zone or use district in which premises are situated /{~f.O..~¢~..t~..o .... ' ................ 12. Does proposed construction viClate any zoning law, ordinance or regulation· . tog ...... 13. Will lot be regraded ,00 ....... ' ' ' ................ ......... . .......... wm excess nJl be removed from premises:'" 14 Name of Owner of premises [,~.t¢.~..¢. Address ~.tFP.67 · Name of Architect ' 'i ............................ Phone No. ,5-.r.* .~.~ .5(..g~. .... .......... Address ~Phone No Name of Contractor ........ 1 ................... Address .... ~ ............... Phone No ................ 15. Is this property within 1300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold iTown Trustees Permit may be required. ... I PLOT DIAGRAM 'i Locate clearly and distinctly al! buildings, whether existing.or proposed, and. indicate all set-back dimensions from~ property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether' interior or coruer lot. APP. ROV£D AS NOTED ' / 785-,1802 9 ~M TO 4 ~ ~Ot. LOWfNG ~NSPECTIONS: FOUNDATION ~0 REQUIRED ~OR POURI}D CONCRETE ROUGN - FRA¢~ING & PLUMBING ~ONSTRUCTION MUST CONSTRUCTION SHALL MEET REOD~RE~E~S OF THE N,~ CO~ES, N~ RESPONSIB~ FOR DESIG~ OR C~RU~ION ERROR8 3TATE OF NEW Y,O Rgb, . :ouFr¥ sLs ............................................... being duly sworn, deposes and says that he is the applicant (Name of individual signin :contract) ~bove named. is the ' (Contractor agent ...... ~ ............................ , , corporate officer, etc. said owner or owners, ~d is duly ':authorized to perform or have perfomed the said work and to m~e ~d file this pplication; that all statements contained in this application are true to tlie best of his knowledge and belief; and that the .'ork w~l be perfomed in the m~ner s'et fortli in the application flied therewith. ~vom to before me this , ..................... dayof. ~% ..,19...