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Home My WebLink About21998-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENt' TOWN HALL $OUTHOLD, N.Y. N~ 21998 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~.,'.~.......~/~...~..... ~z.~ ...................... .~:.....0...~../.~i~..~. ........ ~.~......~:...7o~' ..~.~.,.~....,,....~..f.., ........ Z/...q..z./ ....... ~ ....... . _ to .......'~....~..~.~ ........... ~ ......... ~.-r:~....~....../... ~...'~........~ ........ ~.'~........../..~,/.~,'~, .. ..z~...,..~ ........ ~2z.,..,z.........,?~4 .......... ~', ...... ~~ ........ ~ ............. ..~...~: ....... ~...-. .................. ~_.,. ................................................................................................. at premises located at ................ ~....~.....~..~..'~. ......... ...~.....~.../....'~.. ........ -.~....'. ............................................ CountyTax Map No. 1000 Section ...... ,,'~',,,'~,. ............ Block ....... ..~?../.. ........... Lot No ........ ...~,...~... ........... pursuant to application dated ............. ...'~.../~ ........................... 19....~..~.E~-.., and approved bythe Building Inspector. Fee ~..,..~'.~ .... Bull[ding Inspector Rev. 6/30/80 Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 . (BuilC/~g ~hspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORM .............. t,Oy ~ - .__ /. MAIL TO: , Date .................. i' 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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 hhis appli- : cation. 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 shall 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 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admi,t authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) ...... (Mailing address of ap~liqanO State whether applicant is owner, lessee, ~gent, architect, engineer, general contractor, electrician, pluniber or builder. .............. . ................... · .............................. As..NO.T.m .... Name of owner of premises . .F~.'~./.ff'd?cf/2~) /7Z--~;~6-~ ~/~/7z~ ...................... , ..... .*,' '. ..... .; ' '; '.' *FEE:' ' "J:'5' ~'*~ .... I~:.- *,( "' '; r'~'~ · [as on me tax ton or ~arestl~f.,)/ BUILDING DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOVVING INSPECTIONS: ,I. FOUNDATION - TWO REQUIRED ............................................... FOR ~OUREO CONCRETE (Name and title of corporate officer) 2, ROUGH - FRAMING & PLUMBING Builder's License No .......... , ..... 3. INSULATION ........... 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR~C;Q~ Plumber's License No ......................... ALI. CONSTRUCTION~ SHALL MEET THE REQUIREMENTS OF THE N.Y. Electrician's License No ....................... STATE CONSTRUCTION & ~ ENERGY CODES. NOT RESPONSIBLE FOR Other Trade's License No ...................... DESIGN OR CONBTRU~N ERRORS Location of land on which proposed work will be done. ........... IIouse Nmnber Street Hamlet County Tax Map No. 1000 Section ...~7.~. ............ Block .../. .............. Lot...~. ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy ............................................... ~ ........... b. Intended use and occupancy .................................................................... o lO. Il. 12. 13. 14. 15. property lines. Give street and blocl~ interior or corner lot. Nature of work (check which a~plicable): New Building .......... Addition .......... *~l~' ~! '.. Repair ........ ...... Rem:oval .............. Demolition .............. Other {Vor'~. ~.~.'°..~.. uma[ea cos[ ~.~.~.~ , ~ (to be prod on fihn~-it~on) If dwelling, number of dwelling] units ............... mumoer of dwelling units on each fl0o~": 7'.-~ 7'. ......... If garage, number of c~s If bumness, commercml or m~xed occupancy, specify nature and extent of each type of use .................... Dimensions of existing structures, if any Front Rear Depth Height ............... Number of Stories ..................................... D~ensions ~' · · · of same structure ~th alterations or additions Front ................. Rear ................. Depth HeiSt Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories ............................................. -. Size of lot: Front ' Rear Depth Date of Purchase .......... ~ .................. Name of Fomer Owner ............................. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No Nme of Owner of premises ...~ ................. Address ................... Phone No ................ Name of Architect .......... i ................. Address ................... Phone No ................ Nme of Contractor ........ S ................. Address ................... Phone No ................ Is this property within 300 feet of a tidal wetland* *Yes ....... No ......... · If yes, Southold Town Trustees Permit may be required. ~ PLOT DIAG~ Locate clearly and distinctly ~1~ bulldogs, wh~ther existing or proposed, ~d~ indicate ~l set-back d~ensions from number or desc~ption accord~g to deed, and show street n~s and indicaIe whether fi~'~ ~ ~ ":h ' 'i' · ~ ' ' .;.'i ;gg:":' · ............... being duly sworn, deposes and says that he is the applicant : /. (N me ~ua~;ii~l' contract) He is the (Contractor , agent , cOrporate o rice r, etc ) of said owner or owners, ~d is duly]authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owle~ge and belief; and that the work will be performed in the m~ner ~et forth in the application filed therewith. Sworn to before me this Nota~ Public,~~~/. ~y Nota~ Publio, State ot ~sw York ...... No. 4951 ~6~ (Signature o[ applicant) Oua,ified in Commission Expires MaY 22, 19 ~ . aq~'oHznos ~to NMOJ~' · J~aa '9~1~