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Home My WebLink About21536-zFORM NO.?, TOWN OF SOUTHOLD BUILDING DEPARTMENT lawn ~ BOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ........................................................... 19 .~,...'~..... 21536 Z Permission Is h,efcby_granted to'., ...... .. at premises located at.....,~...~...~., ................ ~ ................i ......................................... County Tax Mop No, 1000 Section ....... '-~..-~,~'.... ...... Block, ....... 4~..,.~,.. ........ Lot No .......... .4~, ,.~,.. ........ pursuant to application dated.... ,~..~/' ...................................... 19 ..?~.. ....... Building Inspector. and approved by the Rev. 6/80/80 O~ , l) RAILROAD AVE. ( YOUNG$ AVE, ) Zo o > ~ m ~ 0(~ ~0~00 4~ -- 0 CTM C~ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....... ,19 .~..~ Approved....~.~.~.. ....... 19~. Permit's- No..~'...~'~.~. ~..~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FOK~I ..,,,,,.o..,.. NOTIFY ~ CALL ................... HAIL TO: INSTRUCTIONS a. Th/s application must be completely filled in by typewriter orin 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 this appli- cation. c. The work coverdd by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will isgued 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 ~hali 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 ali app/ieable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ..... c (Mailing address of applicant) Al L{ ~ }~ -/~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ q ~..r:~..,:~.. ).. ~.~.~.,-.o-~...*o. ~ ............................................... :Nameofownerofpremises .. ..o,..e?..~.~....L.,.0.c[.~...~..~...~Q..\' .~A.~...~.~..~.~...6~...~.. .~....c'cO~.~.~j~l[~. (as on the tax roll or latest deed) If applicant isAa corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No .... /.~.~ ff.. ~.~...~...--~.. ...... Plumber's License No ......................... Electric~ian's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number -- Street " Hamlet Co ,nty Tax No. lOOO Section . Block ?. . ot. . Subdivision ..................................... Viled 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 Intended use and occupancy ~E.DC~ 3. Nature o£woxk (check which ' ' applicable): New Building .......... Addition .......... Alteration Repair .............. RemoVal . 4. Estimated Cost ....... ............ Demolition .............. Other Work ............... Fee '~ (to be paid on[filing this application) If garage number of cars. ...... 6. If business, commercial or mixed!occupancy, specify nature and exteht of each type of use .................... 7 ...... if any: Front Rear Depth . Dimensions of ex~stmg structures; ......................................... Height ............... Number of Stories ......................................... Dimensions of same structure with alterations or additions: Front Rear ........... Depth ! Height Number of Stories 8 Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front ............ .......... Rear ...................... Depth ................... I0 Date of Purchase ~' . Name of Former Owner 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: .................... 13. Will lot be regraded ..... , ..... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... l ................ Address ................... Phone No ................ NaiVe of Architect ~' Address Phone No Name of Contractor .......... l ............... Address ................ Phone No ................ 15. Is this property within 300 feet of ~ tidal wetla~'d'? *Yes ........ No ......... *If yes, Sou~hold Town Trustees Permit may be required. ! PLOT DIAGRAM Locate clearly and distinctly all 6uildings, whether existing or proposed, and, indicate all set-back dimensions from , property lines. Give street and block nhmber or description according to deed, and show street names and indicate whether interior or corner lot. ' If dwelling number of dwelling ulnits Number of dwelling units oh eac~flo0r Al)PROVED AS NOTED NOTIFY BUILDING OEPART~/1.E,N 765-1802 9 AM ~ 4 PM~OR THE FOLLOWING INSPECTIONS:. 1. FOUNDATION - '~0 REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ~NSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL ME~ T~E EEQUIREMENTS OF THE STATE CON~RU~ION · ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, , ..... · :. ...x ........ ,....... ..... being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) above hamed. lie is the ................................................................. (COntractor, agent, corporate officer, etc,) . of said owner or owners, and is duly authorized ~o perform or have performed the said work and to make and file this application; that all statements contaim d in this application are true to the best of his knowledge and belief; and that the work will be perfo ~/?ned in the manner so t forth in the application filed therewith. Sworn to before n{~ this ........................ day of.. Notar~ Public ....... .~..'?<...~)...~..~.. .~ERNADETTE L ~QTARY PUBLIC ~ S~ of N~ York R~iding in Suflak Cou~y ~ ~ / Commission ~plr~ ~ ~0, ~ ............. County (Signature of applicant)