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Home My WebLink About21341-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~? ~1341 Z Permission is ,hereby granted to: at premises located at .......,~., ,,~'. ,~., ....... ~.,?~ ....... ~ .......................................................... .................................................... .......................................................................... Co~n~ *o~ ~ Uo. ~000 S~,o~ ..... ~ ........... ~,~ ........ ~ ....... [o~ Uo...~ ............... Building Inspector. Rev. 6/30/80 ~! 13 ! APR I 2 1993 .oRM NO. ~ ..~,.//. TEL.: 765-1802 Examined · ~. ....... , 19 ~ Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets 0f 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 9reas, and giving a detailed description of l~yout of property must be drawn on the diagram which is part of thJs appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tliis 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 a0y purpose whatever until a Certificate of Occupancy shall have been granted by the BuildLng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon~iOr~ii~a'n~bf¥tib Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations for ~)ae qonstruction of buildings, ad~ditions or alterations, or for removal or demolition, as herein described. The applicaltt agree~ :t6 cofnpl9 With'all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises'and in building for necessary inspections. o . (Signature oL0/pplicant, or name, ff./a corporanon) P,.o, ~.~ s.~':. ~o.~'1~ ~t J...I~ ,/..~.r..q .q j.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~. ~-,-,..r-,~.,,. l...C~,.,~.,: r..o, :,~r...o.~.. ......................................................... Name of owner bf p't~mises (as on the tax roll or latest deed) If applicant is a co~po~ation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...1 ,.D,,.~k .~..~....~...~. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ' ' · .e/.'.-/6. o ....... ~. ~ f,.,~.-r .... ~.-,,..~ ........ .Q.,..,--,...~.t.., ~, .. ,o.~_~...I. !.~ ~ ~.... llouse Number ' ' Street. i~alnle(~ ' '" County Tax Map No. 1000 Section ..... .~..C ......... Block ..... ~7. .......... Lot ...... .~. .......... Subdivision ..................................... F, iIed Map No ............... Lot (N:nne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ( ~ppli ) , · 3. Nature ofxvork check which cable: New Building .......... Addition .......... Alteration ........ Repair .............. R6moval .............. Demolition ~ Other Work 4. Estimated Cost ~o ~ (Description) 5 If d elli ~ (to be paid on filing this application) nb fd 11' ~ it N~mb fd Iii · w ng, nu crc we m un s ............... t crc we ng units on each fl If garage, hum her of cars .... [ ...................... ocr .............. 6 If b i i I 9d y sp cji ' d ........ · us ness. commerca or mix' occupanc , e y nature an extent of each type of use ............. 7 Dim ion f xi ti if F ....... . ens so e s ngstmctu~es, any: ront ............... Rear ............... Depth .............. Hy ght . . ............. Nu&- D~mens OhS of same structure ~ith alterations or additions: FrontRear Depth I IIm~t ............... 8 ................... ' ......................... Number of Stories .......... . Dimensions of entire new cons~mctlon: Front Rear ' Heiel~t Nueber of Stories .......... Depth 9 Size of lot: Front I ....................................................... I0' Date of Purchase .......... i ............ Rear ...................... Depth ..................... 1 I' · ......... ! ................... Name of Foyer Owner ............... Zone or Use district in which p~emises are situa*~ 12 Does proposed construction vi~late an ~..'' 'L' .......... "'~ zonin oramance or regala~l~n: ...................... 13 W~llot be regraded . ' ' · ' r.', .................. Will excess fill be removed from ~remises' Ye 14. NmeofOwnerofpremises ~.~,a ..~n.~ ~ ~- ~ ~ · s · o ~: ...... '~ '2~'~''~aaress~.O~14~PhoneNo. 15~ ..... p~uperry lO.tea witsin~o0 feet of a tidal wetland* ~YES . ~''['~'' y . Southold Tow~ Tr'ustees Permit may be required. ' PLOT DIAG~M Locate cle~ly ~d dist~ctly ~ bulldogs, whether existing or proposed, ~d, indica~e MI set-back d~ensionsifrog prope~y Hnes. Give street ~d block~number or description accordin to d . · · interior or comer lot. I g eed, ~d show street nmos and mdmate whethe: FEE: ~BY: · ~ 765-1802 9 AM ~ 4 PM FOR'~HE , i ~ * FOLLOWING INSPE~IONS: ~,1¢o~ ~ 1. FOUNDATION ~0 REQUIRED , ; - , , FOR POURED CONCRETE ' ~ I ~i ~ 2. ROUGH - FRAMING & PLUMBING / ff 3. INSULATION ~ ~ ~ 4. FINAL CONSTRUCTION MUST I ~ ~ 8E COMPL~E FOR C.O. t ~ ~ ~o~ ALL CONSTRUCTION ,SHALL, ME~ ~ ~ THE REQUIREMENTS OF THE N.Y. t ~ STATE CONSTRU~ION & ENERGY / ~ ~ CODES, N~ RESPONSIBLE FOR I ~ ~ DESIGN OR CONSTRU~ION ERRORS t I ! (Name olindivldual signi'ng c~nt~a~t~ ........ being duly sxvom, deposes ~d says that he is the applicant above named. Ilo is the ...................... ~ . .. ~ ....... of said owner or owners, ~d is dul~ ' '. , ~ authorized to pc,rform or have performed tim ~aid work and to m~e 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 perlbrmed in the m~ner[set forth in the application filed therewith. Sworn to betbre me this ~1~ In S~ ~0~ "~ ~ w (Signature of applic~t)