HomeMy WebLinkAbout21290-z ~0~ NO. ~
TOWN OF SOUTHOLD
I~UILDIHG 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? 21290Z
...... ~.~...~...;.,.~...,./...,......~ ~-~. ~
County Tax Map No. 1000 Section ..../.....~...~... ........ Block ....... ~ ......... Lot No..../.....~... ...........
...... ~ .~... ~. · 19~..., and approved by the
pursuant to application dated .. ~ .................................. ,
Building Inspector.
Rev. 6/30/80
stet
874-2449
Box 220, Speonk, N.Y. 11972
Wood
" Hei .F. ht (,~ r Height
, quantity.
z"~ ~o~t~ ~,'r ,,,q~. O~ ~o~.
Co~e~ M ~{ CC~ Cowries,,,
Fnds_ , ~ ~ q Cfr4' Ends,
Lines ~ K k-t CC ~ Lines
Toprail
Wire Gauge,
Coil Wire
Barbwire
Gate Description
Job Description
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~-'i"~(~. ;' FORM NO. 1
TOWN OF SOUTHOLD
i'. 2 199 '
, . MAR
BUILDING
DEPARTMENT
TOWN HALL
¢.i '~"~ SOUTHOLD, N.Y. 11971
L,~,~,,],~i~.!:]:Z ~ ,, ,'"J.:~ TEL.: 765-1803.
Examined r-~/.~. ......... , 19 .>'.~. ~
Approved .......... I ~ ?~. Permit No. ~.. Z~.
Disapproved a/c ...' ..................................
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH ..... '.....
3 SETS OF PLANS ..........
SURVEY ...................
CHECK ....................
SEPTIC FORH ..............
CALL . . ....
MAIL TO:
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
kets 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 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 dexnolition, as herein described.
The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized in ~.~gto~ ~q ~p~y~i~ p ~an d'~,~ ~'~ ~,~ ~., ~ u~ ~ in building for.necessary inspections... ,/..
........................ ~ ~-! ~ .................. 4 ;z .... (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner,~ ~agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~ .f0(-~g~..../q:. ~'~v~$~'~4tJ~eh:74&/ff4~'. ........................................
(as on the tax roll or latest deed)
If applicant is a corporfition, signature of duly authorized officer.
(Name and title of co, orate officer)
Builder's License No... ~/~ ...................
Plumber's License No.. ff/~. ..................
Electrician s License No .......................
Other Trade's License No.. ~/~ ................
1. Location of land on which proposed work will be done.'~ ~e~ .~ --~ .~..~,. .............
..... .... .....................................
House Number Street Hamlet
County Tax Map No. 1000 Section . ~ ........... Block. ~. ............. Lot..~ ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises hnd intended use and occupancy of proposed construction:
a. Existing use and occupancy ../. ~[~ ........................................................
b. Intended use and occupancy .............................. ?..."d??. } .. .... ..................
'3. Nature of work (check which applicable): New Building Addition .......... Alteration .... ;.. i..
Repair .............. Rem~gval .............. Demolition ..... : ......... Other Work...~-~..
4. Estimated Cost ~' "/ o~..OO, oO. . """ ~: ~.
· .~'~ · .' ........................ Fee. ~,.,.OID ........................... '
(to be paid on filing this application)
5. If dwelling, number o f dwelling.U~its ............... Number of dwelling units on each floor.. ..... ........
If garage number of cars .tSJf~. ................ ....
6. If bumness, commercial or m~,xefl occupancy, specify,nature and extent of-each type of use ...Ag'?A., .............
7. D~menmons of exmbng structures, ff any: Front ............... Rear .... ............ Depth ...............
Height ............... Nun~ber of Stories ..... ~...: ...........................................
Dimensions of shme structure with alterations or additions. Front ................. Rear ..........
Depth ..................... !.. Height ........... . ........ ,., Number of Stories .......... '.: ..........
8. Dimensions of entire new construction: Front .............. ~ Rear ................ Depth ...............
Height ............... Num~ber of Stories ............... ;, .............................. - ...........
9. Size of lot Front ..../.OO.,.O.o ...... ' . Rear /.°.O..~?O ............. Depth .d~....O0./.
Date of Purchase . ~.~C--.-. ~., .i ./.~.7. d,2....~ .........Name of Former Owner '. ............................
11. Zone or use district in which pr{raises are situated ............................................. ~ .......
12. Does proposed construction violate any zoning law, ordinance or regulation: . dLdQ ........................
13. Will lbt be regraded . ..ADO. '..: ............ Will excess fill be removed from premises: Yes
14. Name of Owner of premises ...! ............ ~ ....Address ................... Phone No ................
Name of Architect .......... i ................. Address ................... Phone No .................
Name of Contractor ......... 1 ................. Address ................... Phone No ................
15.' Is this property within 300 feet of a tidal wetland? *Yes ..... ~.. .......
· *If yes, Southold %own Trustees Permit may be required~'' ~
PLOT DIAGRAM
Locate clearly and distinctly all I buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether
interior or corner lot.
AI ROVED AS NOTED
.om OE A r ;r AT
765-1802 9 AM TO 4 PM FO~I THE
· FOLLOWING INSPECTIONS:
1. FOUNDA'OON - TWO REQUIRED
FOR PODflED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
13E COMPLETE FOR C,O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF TIlE N.Y,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW~YQ.R~
r'~lS. ~.t:.fd:('~q,.q-CZ.. ........... being duly sworn, deposes and says that he is the applicant
(Name of individual signiflg contract)
above named, i
He is the ...............................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this
application; that all statements contaihed in tliis application are true to the best of his knowledge and belief; and that the
work will be performed in the manner 'set forth in the application filed therewith.
............. y of .... ,19..'.
~..~...~. County
Notary Public,
Notery Publ~o, State of New York ' ' '
No. 4879505 i (Signature of applicant)
- Qualified in Suffolk County ~ z~
uommlsslon Expires December 8,