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Home My WebLink About21596-zr FORM NO.$ TOWN OF SOUTHOLD BUILDING DEPA~TMEN~ TOWN HAU. SOUTHOLD, N.Y. N~ 21596 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ~ , ~/ ~,~=~....~~.......~.~.,. ................ . ..~,....._~..~...~. ...................... v .................. , ..~~../.,~.~..~..~..~_~.~...: ....... to .~~..~¢,........~. ......... .' .~.~.,........~...,.. ~.. ~ ...................... .~-/,r~... ...... :~ ............................................................................................................... CountyTax Map No, 1000 Section ....... ,~,.,~..,, ..... Block ........ ~ ............. Lot No ....... .,./,.~.. ............. pursuant to application dated .........~..~..' ................................... 19.~.,~ ......and approved bythe Building Inspector. Fee $ ............ .~(~,~ ..... '" ~~l~i~J' Inspecto; ...................... Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 f .,/~.~ TEL.: 765-1802 Examined- 'I2'~ ......... 19¢:~ ' '·.. ^pproved ............... 19~.. Pe;mit No. ~.../..~..~. Disapproved a/c ..................................... . (Building I sr(~ectdr) APPLICATION FOR BUILDING PERMIT SHARD OF HEALTH 3 SETS or PLat{S SURVEY ClIECK ..--- .... ., ......... SEPTIC CALL ............. MAIL TO: Dat ................ 1.9 INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 stkeets 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessary inspections. ,.~ . (Signature of applicant, or name, if a corporation) State whether applicant is owner, e, agen , Z~ct~engi.-:.zcr, gerrtrrai 'contractor, electri~r or buil4er. Name of owner of premises (as on the tax roi1 or latest deed) If applicant is a corporation, 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. -3( 1. Location of land on which proposed work will be done .................................................. ~ ~.~'~;'~' ).~./.,r.~ ....................... '. 0~¢ ck . ltouse Number Street Hamlet County Tax MapNo. 1000Section ...: ....... . ....... Block ......... ' .. Lot.. Subdt is:on ....................... · .... .......... Filed Map No. Lot ............... (Nmne) . ' 2: State existing use and. occupancy of premises and intended use and occupancy of proposed construction: a. Exisdug use and occupancy / ~~q ...~.~4~ u,, ....................................... Nature of work (check whicl~ applicable): New Building .......... Addition .......... Alteration .... ; .... Repnlr .............. Removal .............. Demolition .... : ......... Other Work../j~?..~.q.~..... ' . .-~.~. ?! -/-: '"" . ..~.~..~. (D ipti n) 4. Estimated Cost ...... ' escr o , (to be paid on filing this application) 5. If dwelling, number of dwellii~g units ...... /'. ....... Number of dwelling units on each floor .... ~ ......... Ifg age, b rof ;Z..-- ' ~<6 If bus' lo it d ...................................... .~5~"' )g7' nless, commercm r m e occupancy, spec~£y nature and extent of.each type of use ................ Di i fexi ti gstruct~ if y: F · s, R D pth .... mens ons o s n re an rent ............. ear .. e ......... It ight N' b fStoi ' ' ' ' ............. e ............... tun ere res ..... ' .... Di sions of shine tructu ' 'th It ti dditio' ............................................ ~" men s relwl a era ons or a ns: Front Depth ' I Height .................. Rear ................. >z8 " .... ' .................. ,.. Number of Stories ' · Dimensions of entire new construction: Front ................... .............. : Rear ............... Depth ............... eight ............... Nfimber of Stories ............................................. s'H'izeoflot:bront ......... !.: .... tS.i.. Rear ....... :.. Depth . .. '. '" Date of Purchase .,O-J,~- ,? /~.oo' .' ' . Name of~ .... .... "' ' --¢ ,~'~' ' *' *'2,;;' .... · ~ r/~7 .............. rmer uwner . .d'. ..... ~'~ ......... Zone or use district in ~hich premises are situated ,z~.e.j'~,,~.~., ~-,~ / ..... . ...... Does proposed Constrt, chon w:olate any zoning law, ordinance or regulation .' . . . ' ....... Will lot be regraded ....... i ................... Will excess fill be removed from premises: Yes ., No Name of Owner of premises .... '~..'~..'Cf ~ .... Address .... -~...,?.,~/..r-x.. ....... Phone No.~...~:-~.~ 4'~72d~'. Name of Architect ........ i.. ............ ' .....A/ldress ........ ' ........... Phone No ...... i. ' ........ Name of Contractor ....... q .................. Address ............ ; ..... Phone No/ ......... ;..'. ';.. I.s thio property within1300 feet of a tidal wetland? e~Yes... ~'If yes, Southoldi Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. 10. 11. .12. 13. 14. STATE OF NEW YORK, NOTIFY 8UIL(Q'fNG DEPART~J~T 78B-]802 9 ~M TO 4 PM F~ THE FOLLOWING ~NSPECTIONS: ~. FOUNDATION '- 'BMO ~EQUIRED FO[I POURED CONCRETE .2. ROUGH - FRA~A~NG ~ P~UMB~NG $, ~NSULAT~ON .4. Fif;~AL CONSTRUCTION MUST BE COMPLETff FOR C.O. ALL CONSTRUCTION SHALL THE,~EQUIREMENTS O¢ THE STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DES~N'O[1 CONSTRUCTION ERRORS $.S COUNTY OF ................. ? · ! ' ~ ............... ~ ......... , .............' ......... being duly sworn, deposes and says tiler he is the applicant (Name of individual signipg contract) . above named... He is the ....... · · ' ' ' .... T (Contractor, tnt, cot rate er, c. , ag po offic et ) ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contailned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manneriset forth in the application filed therewith. ' Sworn to before me this .............. day of... ' ','otary Public ....... : ....... '~q~,c'r{-~.. ......... Count~ LINDA J. COOPER ......... N~ary Public, State of New York o. 4822563, Suffo k'(~ounty Term Expires December ~1, 19 .... (Signature of applicant) .