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Home My WebLink About21212-z FOR. Bi NO, O TOWN OF SOtJTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-~N'? 2121~. Z Date ............. .......... .¢.../. ................... ,I Permission is hereby granted to: ......... ~..,~....~.~ ......................... ......... ~..d...~...~........~...~.,.'~......./...gal.... .............. ,o ~~ ..... ~ ....... 7~ ......... ~;~""~" .................................................................................................... = ......... ~ ........................ ~ ..... ...z~4~' ~ .......... ~.....~(~x&....~., ............................. ~ ............................................ CounW Tax Map No. 1000 Section ..... ~ ............Bilk ~ Lot No. ~ ~..2~, ~ppro~ by t~* pumuant to application dat~ ............................. ~] .................... , and Building Inspector. Rev. 6/30/80 Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ............. 19.~.. Permit No..~/~.'/.'~. ~ Disapproved a/c ' BOARD OF HEALTH . ........ 3 SETS OF PLANS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. hot ~ PY ~ CALL ................... MAIL TO: . t~uilding Inspector) APPLICATION FOR BUILDING PERMIT 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 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 pumuant 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 inspectio~s,~.~//~ "]'f/~"-~/~'-~ ~f, '.~.~..-~.-/.. ,/~,..' , - (Signature of applicant, or name, if a corporation) / 14? & . .V. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. .............................................. , ................... Name of owner of premises....~.~.,/.~[~.~. '~47,t~./~/.~...~.....~..~, ~(~0~ ......... (as on th~ax roll o; l~te;; ~dd)'~t~ ~ ~ ..... applicant is a corporation, signature of duly authorized officer. DA~~B.E- ' ' If .............................................. (Name and title of co.orate officer) FOLLOWING INSPECTIONS: Builder's License No. ......................... FOR POURED CONCRETE Plumber's I.,[cense No ......................... 2~ ROUGH - FRAMING & PLUMEING 3. iNSULATION ~lcctrician's License No ....................... 4. FINAL CO~{STRUCTION MUST 8E COMPLETE FOR C.O. Other Trade's License No ...................... ~ ALL CONST~TION SHALL MEET ~/_~ ~~F~ OF~THE N.~ 1. Location of land on which proposed wor~ will be done ......... ./.~ ~;(.~~T~ .&. EN~, ~ff~~ ~ ~ ~N~ RESPONSIBLE FOR ............................................................ ~ D~tGEQR CO~UCIlON ERRORS.. House Number Street Hamlet County Tax Map No. ]000 Section . . . ~. ~ ........ Block .................. Lot ..... ~ ............ Subdivision ..................................... Filed Map No ........... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiom b. Intended use and occupancy .................................... ,.,;. ........... .~.< ............... .3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteratio~l .... :.. i.. Repair .............. Removal .............. Demolition . ..: ........ Other Work 4,~O ~ ' ' . (Desbfiption) 4. Estimated Cost ....................................... Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage number of cars i./ ' 6. If business, commercial or mp~ed occupancy, specify nature and extent of.each type of use .....*77.. ~ ..., ..... 7 Dimensions of existing structure! if any: Front Rear Depth Height ............... Number of Stories ........................................................ Dimensions of shme structure with alterations or additions: Front ............. Rear Depth I Height Number of Stories 8. D~mens~ons of entare new construction: Front .......... ~ Rear ...... Depth Height Numlber of Stories- ' 9. Size of lot: Front ......... ~. : ..... ~.. Rear ...................... 12eptk ......... , ............ 10. Date of Purchase .... ~.g/tT. . Name of Former Owner ~&~.(ot~£ 11. Zone or use d~stnct ~n which prelmmes are situated ........ ;~ .-~. ....................................... .12. Does i~roposed construction violate,~ny zoning law, ordinance or regulation: ....~..Q ....... 13. Will lot be ~egraded ......... /¥.Q ............... Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises ...i ................. Address ......... .......... Phone No ................ Name of Architect ~ Address Phone No Name of Contractor ' Address Phone No . ....' 15.' I,s this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold ~own Trustees Permit may be required, PLOT DIAGRAM Locate clearly and distinctly all ibuildings, Whether existing or proposed, end, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate Whether interior or corner lot. bad STATE OF N~'~:~ORK')f"2_ /[,-'" - S COUNTY OFFS. C.IX... ......... ............. (Name of individual signigg contract) above named.I, He is the . .~..~ .... . i ('~C°ntra~ct~, agent, corporate officer, etc.) of said owner or owners, and is duly!autho--rlze-d'To perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ;et forth in the application filed therewith. Sworn to before, j~e, this ......... ~.~ .;d ......... ,197.~. Notary Public, . .~..Vt.4:.. ,~... '. County (~/ ~ NoIaW Public, State of New York No. 4879505 Qualified in Suffolk~ounty ~/f (Signature of applicant) ~omml~slon Expires December 8, 19 being duly sworn, deposes and says that he is the applicant