The URL can be used to link to this page

Home My WebLink About21582-zFOI~M NO,3 TOWN OF $OUTHOLD BUILDING DEPA~IMENI' TOWN HALL SOUTHOLD, N.Y. NO_ BUILDING PEI~MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) aa,e.....,¢/../..C ............................................. 2J. 582 Z Permission Is hereby granted to: · ~--~...,..¢.,..~~¢.., ¢~ .¢.... ........................... ..?....*...~.~.....~~~....z2...~.: ................. .....¢,_~~.....~... ...................................... _ ............. Coun'h/'fox Map No. 1000 Seclion ....... ~¢'~, ........ Block ...... .6 ...........Lot No ..... .~..~...../'.,~...'~.. ....... pursuonl to application doted .......'.'.~/,~:...~.. ...................................... 19..,~-,...'~... ...... and approved bythe Building InspectoL Fee $...~.~.. Rev, 6/30/80 Examin JUL ?. 3 993 ............ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c '" ~"/~. (Bsgldin~lnspector) INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PL~$ SURVEY CIIECK ................ SEPTIC FORH a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w 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 st '~or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this 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 p, shall be kept on the premises available for inspection throughout the work. ¢. No building shalI be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup shall have been granted bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desct The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a~ admit authorized inspectors on premises and in building for necessary inspect~ /1 --' (Signatur~ of applicant~r name, tion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui N-~me of owner of premises..!~.~.'.~/.~...~.. ?..~.! '~' '~'(~I¢' t'h'e~' ~a'x~o! i~t'c~)' ' ' ........... ' ....... If applicant is a corporationl signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~...~. ?. ............ Plumber's License No ............... . ......... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................. ; ............ i...'.. .. ..... ltouse Number Street Hamlet County Tax Map No.' lOOO Section .i.:..~...C).. ...... Block i.,~., ......... i... Lot.,./t./ST ...... Subdivision .... .~:."~'.4d(j.~,.~..{~Z... ' ' FiledMapNo...7?.O.Q~..:. Lot ...t~ ..... (Name) 2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... .......... .~.~/.,~/'~ .~. . .~. [~..//!.(_.~ .............................. b. Intended use and occupancy ............. · ................ · ........ ; .......... ;. ....... '3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration,,... Repair .............. Removal .............. Demolition .... : ......... Other Work....~. 4. Estimated Cost ..... :...~,,.~..._.. ........ Fee ........,. ...... :.'.' ...... : ..... (to be paid on filing this applicati, 5. If dwelling, number of dwelling units ............... Number of dw¢1Iing units on each floor, i ~ .. ..... · If garage, number of cars .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of.each type o f use ............... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ......... Height ............... Number of Stories .................................................. Dimensions of s~me structure with alterations or additions: Front ................. Rear ............ Depth ....................... Height .......... : ........ ~.. Number of Stories ........... i .... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ......... Height ............... Number of Stories .................. $ ..................... ' · I "· . o! lot: Front ...'...,'?~. '. ......... :.. Rear ........ ..~'~ .......... .,,Depth .. z~,~e~ ......... 9. Size 10. Date of Purchase ...~./.~ .......... · ......... Name of Former Owner ~ I~J.~.. 1 1. Zone or use district in which premi~'s ?~' *;t,,ated ................................................ 12. Does proposed construction v~oJ~{e any zoning law, ordinance or regulation: ..... '. 2~/.t~). ............... 13. Will lot be regraded ...... ~ y.'~ .......' ........... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .................... Address ................... Phone No ........... Name of Architect ........................... Address ................... Phone No ........... Name of Contractor .......................... Address ................... Phone No ............ 15.' I~.this property within 300 feet of a tidal wetland? *Yes ........ . No ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and indicate wh~ interi~r~or comer lot. ; NOTED DATE: ! 3- ~ NOTIFY BUr 765.1802 9 AM '1'13 4 PM FOR FOLLOWING INSPECTIONS: 1. FOUNDATION FOR POURED CONCRETE 2. ROUGH - FRAMING & 3. iNSULATION 4. FI~qAL CONSTRUCTION BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET ~'~ REQUIREMENTS OF THE N.Y. ~'[ CONSTRUCTION & ENERGY ': NOT RESPONSIBLE FOR ~',;.~ CONSTRUCTION ERRORS STATE OF NEW~ORI~ ~"~. ii//,, ,~ (Name of individual signing contract) above named. Heisthe ' .~~~__ (Contractor, agent, corporate officer, etC.) of said owner or ownem, ~d is duly authored to perfo~ or have pc:foxed the said work and to m~e and file application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that work will be pc:f creed in the m~ner set forth in the ~pplication filed therewith. ., . ....... C~RE L GL~" ~ ~ .................