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Home My WebLink About21695-zFOgM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_O BUILDING PERMIT ITHIS PERMIT MUST BE I(£PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ........................................... 21695 Z at premises located at ...... .?.~..~.i ....... ~ ............................................................ CounlyTox Mop No. 1000 Section ...... ~'..~-~.. .......... Block .......... /. ............. LotNo. ~ .................... pursuant to application dated .......... "'~' '/ .~..~..~...~ ............................... 1 9....~.~.~. ..... Building Inspector. Fee $ and approved by the J ~' Building inspector Rev, 6/30/80 FOUNDATION ( ls t) FOUNDATION 2. (2nd~ ROUGH FRAME & ?LUMBING INSULATION PER N, STATE ENERGY CODE FINAL ADDITIONAL COM~IENTS: 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INS~.ATION FRAMING ~]'~FINAL REMARKS:, DATE ~/~/ ~/INSPECT~ ' TOWN OF SOUTHOLD iiifi 2 2 J993 , BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654802 E×amined . 197. Disapproved a/c ' .......... : ........... ' ........ ' ' ~ . . . ~fldi~ Inspector) APPLICATION FOR BUILDING PERMIT B~)ARD OF HEALTH 3 SETS OF PL.INS SURVEY .................. ClIECK ................. SEPTI'C C^L~.. &¢.&"..~.~¢.~. ....... HAlL TO: INSTRUCTIONS a. Tltis 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 sti'eets or areas, and givi0g a detailed description of layout of property must be drawn on the diagram which is part of this appli- caiion. ~ e. The work covered by tkis 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 thc 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 l?y 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 inspectors on premises and in building for necessary insp.egtions. -- (Signaturp of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. · .~ · Name of owner orpremises .. O.%.~..O,, .~. ...~.'~..o...vy3. )~.~. 3.o..~. ......................................... (as on the tax roll or latest deed) If applicant is a corporationl signature of duly authoriied officer. (Name and· title of corporate officer) Builder's License No....~.~.. ' Plumber s License No ........ ~..o.... ......... : Electrician s License No ............ I~.... ....... Other Trade's License No ...................... Location of land on which proposed work will be done ...... ' ........................... ; .... :. :.' ......... 'a a.· , · ltouse Number Street Hamlet County Tax Map No:1000 Section ...:...~.."/..g'. ...... Block ..... .~.A. ' Lot ~1~ . Snbdivision ........ . ............... · ....... : ..... '. Filed Map No ............... Lot ...... >. ....... (Name) 'ate existing use and occupancy of premises and intended use and occupancy of proposed construction: · 3. Nature of work (check which ,Pphcable): New Building .......... Addition .~ ./'T~/. ~ Alteration }.. Repair Removal ' ............. ~ .............. Demolition .... : ..... ~ .., Other Work ............... .~..~.-.O.~..~.i · . ' ~.~..,~.. ~, (Description) 4. Estimated Cost .. ': ............... Fee (to be paid on filing this application) 5 If dwelling number of dwelling units ' Nurhber of dwelling units on each floor · If garage, number of cars .... i ........ ' .............. 6 If business commercial or mixed occupancy specify nature and .................................... · ' . , extent of.each type of use 7 Dimensions of existing structures if any: Front ..................... ' , ............... Rear Depth Height Number of Stories ' ' '" .......................... Dimensions of shme structure with alterations or additions: Front Depth ' ! Height .................. Rear .................. .................... ~' ' ' ' Number of Stories ' ' · tmenmons of entire new construction: Front ' Rear ............................... Depth ............... Height ............... Number of Stories .............................................. .'~'- ..... Size of lot: Front : Rear ' ~" ' ........ ' ~ .................................. Depth 10. Date of Purchase .......... ! .......... . ......... Name of Former Owner ................. 1 h pr d ............. 1. Zone or use district in whic cruises are situate .............................. 12 d idl g 1 " ...................... · Does propose constructioN v ate any zonin aw, ordinance or regulation. . ................ 13 d .Pg.~ '.~ ........ ' .... : ]- ......... · Will lot be regrade ' · · : ................ wm excess nit De removea ~rom premises: Yes ' No~) 14 N fp Add . amc of Owner o remises .. i ................. ress ................... Phone No ................ Name of Architect ' ' Aadress .............. , ................... ' ........... Phone No ................. Name of Contractor , ' . · . ....... , ................. Address ................... Phone No .......... . ...... 15. I.s this property within BO0 feet of a tidal wetland? *Yes ........ No. ~N ..... · If yes, Southold ~own Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly alii buildings, Whether existing or proposed, and. indicate all set-back dimensions fi, om property lines. ' Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. 7(,:;5-t.802 9 AM 'R) ~ PM FOR THE ~'C'~LL()W~VG !NSPECTtONS: 't. ~:OUNDAT~OR~ . 'iV*fO REQIJ~RED ' -' FO[~ POURED CONC~ET~ BE COMPLET~ F'O~ ALL COM~T~UCTiO~f SHALL MEET TNE R~OUIREMENTS OF THE S~T~ CONSTRUCTION ~ ENEEGY CODES, N(~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF I~EW Yp.}[l~, f}~. S S (Name of individual signing contract) above named. He is the..' .................... ,. . ' (Cent or, ag nt p ffice ) ..................... , ract e , cor orate o r, etc. ' of said owner or owners, and is dulylauthorized 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 fortlt in the application filed~therewith. ' ~worn to before me this ......... · .. ..... , No. 487950,5 ' .~'ZL . . ~;,m"'/ ...... ;2. '" ' ' !; ' ' ' ' Qualified n Sflffelk C.oun~ .2'"[~] ' t~lgnature o1~, Commission Expires Decemoer If~ I~-~/ .