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Home My WebLink About21438-z J'OR~ NO~ B TOWN OF SOUTHOLD BUILDING D£PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-N.° ~1~38 Z Permission is hereby granted to: ................................ ....... ..................... at premise, ,o~ot~d o, ......~...~.~...~. ...... ~..~....~ ........................................................ County Tax Map No. 1000 Section ...... /.~.. ........Block ....~. .............. Lot No ....... c~...~_~? ...... pursuant to application dated ......... ~.~.. ............................... , 19..?..~.., and opproved by the / Building Inspector. Fee $...~....~ Rev. 6/30/80 ~ ~ , TOWN OF SOUTHOLD ~ : TOWN HALL ~ MI~t 2 I'1993 ~ ,, ,, BUILDING DEPARTMENT ,~.~. ....... SOUTHOLD. N.Y. 11971 ~ ../" ' TEL.: 765-1802 Exam'inca,./...~ ./7..\ ........... , 19 ~7~'~ ' ' Approved... ¢;~,. ...... , 19~. Permit No.~..~ .St/~.~...~ Disapproved a/c ' . (Bz.q'l'ding Iff. st~ctor) APPLICATION FOR BUILDINGPERMIT B~ARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY CI1ECK .... '... r:oTl py: c^LL ,. ¢. Z.. HAIL TO: 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 sti-eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this 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 admit authorized inspectors on premises and in building for necessary in,spectio~ns. " x , --' -~ ........ : ..... ~ '{.~ .............. :/~/~'~'~ (Signature of applicant, or name, if a corporation) ~'; '.t~:~ .... ' ' ' ~ ;"'" (Malling address of applicant) State whether applicant is .owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporhtlon sign,~ture of duly authorized officer. (Name and title.of c.orporate officer) Builder s L~cense No ....................... Date .~../?'. I ............ 19 ~.? Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ..................... .' -T~-\~ 1. Location of land on wJlich proposed work will ~e done....~..~.~...~..Q .......... ! .~.'.~:.O.~:?:L{ ............... . . . .... n.,. . .: . . .:. ...... '.:.. . . ................ · House Number Street Hamlet County Tax Map No. 1000 Section .'.:./.'¢Q~/. ........ Block ..~....~.....:... Lot...~..(~..,,~ ..... Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) , State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~,. ~. .. ~ b. lntended use and occupancy . r~.~.-',~! .'.c~ .cra4.. 1: .... !. ' · 3. Nature of work (check which applicable): New Building . ~ ........ Addition ......... Alteratio~ ....... ~.. Repair .............. Removal .............. Demolition ...... : .... ~ .... Other Work..-¢~..z.¢~,<- ...... · ' ' ~.. '"" ' ~' . . /(Description) 4. Estimated Cost ..... ~/.~..(~..d). i.: ................... Fee ............ ~ (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ........ If garage, number of cars I ......... · If business, commercial or mixe~ occupancy, specify nature and extent of,each type of use ............. 7. Dimensions of existing structures if any: Front Rear Height Numl~er of Stories i ................................... · ~ .......... Depth Dimensions of shme structure w:ith, alterations or additions: Front ii l~ear i Depth Height ~ .................... ~ ............. ' ......... ... Number of Stories .... ' ' 8 Dimensions of entire new constrUction: Front .................. · Rear Depth Height Nuniber of Stories .............. ~ .............................. 9 Size of lot: Front ! ....................... ' ................................ ' Rear Depth 10' Date of Purchase ......... ' ...................................................... · ' Name of Former Owner 11 Zone or use districi .......... : .................. ' ............................ · in which pr~mises are situated · 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ' .............. 13. Will lot be regraded ....... ; .! ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...i ........ , ........ Address ..: ................ 'Phone No .............. ~. ' Name of Architect . ............................ Address ................... Phone No .............. Name of Contractor ......... i ................. Address ............... . Phone No ...... ' ' ' . 700 .......... , . o 15.' Is this property within feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town 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 :lumber or description according to deed, and show street names and indicate whether interior or corner lot. r APJ O D AS NOTED 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I, FOUNDATION o TWO REQUIRED FOR POURED CONCRETE 2. ROOGH -FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OFNEW YORK, g.S OF ............... ~ : F~.~ ............. . ...... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) ' above named· ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly [anthofized to perfom or have perfo~ed the said work and to m~e and file this application; that ail statements contaihed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner }e~ forth in She application filed ~herewith. Sworn to before me this ~ota~ Public, . ...... ~.. ....... ~ ...... Coun~ Nota~ Public, Orate of ~,w Yo~ ~o. 4022563, Suffolk ~oun~m., (Signature of applic~t) Term Ex[ti~s Oocember 31, 1 ~...~