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Home My WebLink About21207-z FO~,M NO. ~ TOWN OF $OUTHOLD BUILDIHG DEPAItTMEHT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°N? 21207 Z is hereby granted to: ~__ ,/9 _ , ~ ,~ ~ ................................................... . ..... et' premise~ located at .......................... ' ................................................................ County Tax Map No. 1000 Section ...... .~...~... ........ Block ........ ../.. .......... Lot No .....~.~...../... ........... pursuant to app',catlon dated ......... /./....',~... .......................... , 19,,~,~, and approved by the Building Inspector. Fee $....,.,....'~"-' ...~./~.. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... C~ECK ~ .................... SEPTIC FORH ................ NOTIFY CALL .... (~lildinj~SYn sp e c t o r ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs 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 lhyout 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 ~hall be kept on the premises available for inspection throughout the work. c. No building shall be occupied or used in whole or in part for agy 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 Bu/lding 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 ~emoval 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 inspections. (Signature f-o.~plicant, or flamai.!Y a Corpbranon) p..,..o., .~ o. ~..s'.~.'.~.,,:,;,..& .o. [ d .~'i..i.i an.r. (Mailing~address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... · ~".."*..,~-r.~,. [.. ~ ~ ~. p.wr.o ..c: .......................................................... Name of owner of premises ....... ~.~.':E.: ¢--~f>k n.-~r~,..~...e~..F.C ~.~.~.'1'7. ...................... (as on the tax roll or latest deed) If applicant is a corporation, sign.ature of duly authorized officer. (Name and title of corporate officer) Builder's License No...1.~. ~...C~..I.. J.-[ ~. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ......... ' ................... . · .~. ~ ~.. ........... ~ o ........... House Number Stree[ Hmnlet County ra× ,~ap No. lO00 Scetio, ..... .'2. ~ ......... ,~l~c~ ....... I ........... Lo, .... ~.t ........... Subdivision ..................................... F, ilcd Map No ............... Lot ............... (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~..~'~ ~,.n~ ~ ¢~..~.., t.~.. 3. Nature of work (check whict applicable): New Building ..... ' ..... Add t on ......... Altert~n ........ Repair .............. R. 'moral .............. Demolition ........... Other Work z. ~o.~oo-.-,-.. scnpt:on) 4. st,mated Cost ....... : .(.~ 2t .qD .~.(D .'~) ................. Fee ...... ~ .e~. ................ (to be paid on filing this application) 5. It' dwelling, number of dweili~g units .............. Number of dwelling units on each floor ........ ~ ...... I£gara. ge numberofcars ..~ ................................................ 6 If business commercial or mixed occupancy specil ................... · ' 'y nature and extent of each type of use ' 7 Dimensi°nsofexistingstruct0res ifany: Fr'' ont Height Numl~er of Stories · ·, ............ Rear ............... Depth .............. Dimensigr;; ............ ' ...................................................... of same structurelwith alterations or additions: Front Depth i Height ................. Rear ....... .................. i ............ Number of Stor/es .......... 8 Dimensions of entire new con}traction: Front .............. ............... Rear ............... Depth .............. igl ~? fSt ' He xt ............... · tuber o ones .............. : ................... 9 Si F .................... · ze of lot: runt ..................... Rear ...... De 10. Date of Purchase ~ .............. pth ................... 1 1 ......... 1 .................... Name of Former Owner ............................ · Zone or use district in which premises are situated 12 Does proposed ¢onstrnction violate any zoning law .......................... · ordinance or regulatio'n': ~O. ~ i ..................... 13. Willlot be rfigraded . ..... ' ' '. '~ I' l .... .. · .~. ·., ......Will excess fill be removed from remises' ~,~. rqame oxOwner ofprem~sesO.~.e~..%~x,. D~"{-'~, z ~-..~_, r'~ , ~ ~ e ~ t P ~_ . Yes N~,-~ ~e ^.~.:,~_. ', ....... ,.~.-~ ~. ^~uress ....'gt~.n~. ;~t.~.og'Y~ldPbone No. ]6,.~?, {3 1~..5~. ~.,-'"~ o~.Z ..... ~t.e~ ..... ~' '? .~:.: ............... Address ............ p~,~.,~ ~ ~ ~ ~,-,~=u wxu~n~uu zeet oz a txdal wetland.* ~¥gs .... NO.~t.. · If yes, Southold To~n Trustees Permit may be required. · .. I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions il'orr property lines. Give street and block number or description according to deed, and show street names and indicate whethe: interior or corner lot. I Nb~IFY BOigfi~ D~PART~Y 765-1802 9 AM ~ 4 PM FOR ~THE FOLLOWING INSPECTIONS: ~ ,-- 1.FOUNDATION ~0 REQUI,RED FOR POURED CONCRETE 2.ROUGH ~ FRAMING ~ PLUMBING 3.INSULATION 4. FINAL CONSTRUCTION M~UST 8E COMPLETE FOR C,O. ALL CONSTRUCTION SHALL ME~ APPROVED AS NOT£D J DATE: ------------- B.R # _ I FEE. I N~)¥1F¥ ~UiL~iN~'OE'pARTD1Et, D 3. INSULATION '. 4. FINAL CONSTRUCT/ON ltSUSfr 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONGTRUCTION ~ ENERGY THE REQUIREMENTS OF THE iN.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE ,FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NElVXO~.. [~. ~ COUNTY OF. ~b k~ ..... [~'~ I ....... (Name of iz~ividual signin- con above named. I ~ CODES· NOT RESPONSIBLE FOR ~DESIGN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant Ue is the ..................... or, ag ffi;e; ........................... j ract ent, c orate , . of said Owner or owners, and is dul~ authorized to pe,rform or have performed the said work and to m~e and file this application: that all statements conta~ined in this application are true to the best of his knowledge and belief; and that the Work will be performed in the ~a~set forth in the appl cation Qled therewith. worn to before me this · , ............. (Signature