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Home My WebLink About21292-z FO~'t NO. ~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21292 Z Date 1 Permission is hereby granted to: ..... .'~.~........../...o...6.~ ...................................... _ ,o pursuant to application dated .... ~...~'.t......~ ........... ,,~,...~. ............ , 19.~..~., and approved by the Building Inspector. Re~ 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .SOUTHOLD, N.Y. 11971 TEL.; 765-1803 Approved..~ .~..°1.., 19~.~ Permit No. c~./..D:~.,~....'~ Disapproved a/c ..................................... ; (Building Inspector) APPLICATION FOR BUILDING PEFIMIT 2 $ t993 .... INSTRUCTIONS BOARD OF H!rALTtt ......... 3 SETS OF PL.'[~{S .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. NOTIFYI CALL ................... HAIL TO: Date ................... 19... a. This se 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 w6rk. 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, ~for removal or demolition, as herein described. The appUcant agrees to comply with all applicable laws, ordinances, ~uTllding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ifi's~gections. ...J. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. · (Name and title of co¢orate officer) Builder's License No...J'? ¥~ ~ ~ ~4 Plumber's License No ......................... Electric, ian's License No ....................... Other Trade's License No ...................... Location qf land on which proposed work will be' done .................... House Number Street Hanflet County Tax Map No. 1000 Section .................. Block Lot Subdivision ..................................... Filed Map No ............... Lot (Name) State existing use and occupancy of premises and intended use an~l occupancy of proposed construction: a. Existing use and occupancy ...... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Remo,val ............. Demolition .............. Othel}~W?rk...P.~.~. l~ ]". ..... .~.0l ! ~ (Description) 4. Estimated Cost ..... :7. · 'I ........................ Fee .,. ~ ...... ' ......... ........... ,~ (to be paid on filing this application) 5. If dwelling, number of dwelling dnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..., .......... 6. If business, commercial or mixed occupancy; specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............. Rear .... Depth ............... Height ............... Number of Stories Dimensio fs .., .;ih alt at;on dditions F ........................ ns o amc structur~ w er s or a : ront ................ Rear ................. Depth i Height Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height Number of Stor/es 9 Size of lot: Front i Rear ............................................ Depth ...................... 10. Date of Purchase ........... 1' ',' "'. · .' ....... Name of Former Owner ................ ' ......... 1 I. Zone or use district in which pre/niscs are situated ................................................. ' ' ' ' ¢ .... 12. Does proposed constructio ol 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 ' Address Phone No Name of Architect ........... , ................ Address ................... Phone No ................ Name of Contractor ................ Is this property within 34)0 f~et' ~f' ~ .... Address ................... Pho0~ No ................ tidal wetland? *Yes ........ No..,~ ...... · If yes, Southold Town Trusi:ees Permit may be required. .. I 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 r. umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~-YORK - ~ 8E COM~ LE ~F~ FO8 COU TyOF Z SPq. . ' ~LL CONST[~UCT~Oht S . .. , .......... k{ ................. being duly ~wo~a,'c~om~a~mm-~ ~ i[~licant (Name ofindividualsignin contract) CODI?$. ~OT ~8~ONRIBIE above named. O~St(~l~ - . O~ CON~3 truer ON ERRORS fie is the ........................ , ................................................... ~ (Contractor, a~ent, corporate officer, etc.) ff s~id owner or owners, ~d Js duly ~uthofizcd to perform or have peffo~ed t]]c said wo~ and to ~pplJcation; that all statements contaim d ~ this application are true to the best of his know]ed~e and belief; and that the .york wQ] be perfo~ed Jn the manner sc t forth in the application Q]ed ~wom to before m~thzs ........... ~ .... day o~d. ~~., 19~ ~ota~Pubh%_ . · County ~ . ~S~eo¢~ ......... ~. . ~ .................... _ 9u?~L~ in Surfak Cou~ ~ / ~ ~ (Signature of applicant) FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL