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HomeMy WebLinkAbout21357-z F~RM NO. 2 TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDI~IG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_No. 21357Z Permission is hereby granted to: / ~'~ ~~...~....~...~...~.~ ..~........../.~: ......................................... .~...~......~..: ......... ;~....:. ...... ..':._~_~....~...~.~ ............................... at premises located at ...c~.,. ~,,~......~,.'~...~ ....... ~ ........ :.~ff,~...~.~ ....................................... Co,,r,~, To,, Mop No. ~000 Sect,o,, ........ .~.~. .... E,,oc~, ......... ./.. ......... Lot No ..... ./...£ ........... pursuant to application dated ............... . .~..~**./**~.. ........................ , 19,,~..~., and approved by the Building Inspector. tar Rev. 6/30/80 'OUNDATION {2nd) FRAME & -PLUMBING ~ISULATION PER N. Y. STATE ENERGY CODE FI;;AL ~DDITIONA'L COMMENTS: FORM NO. 1 ~\PI~ I 9 1993 TOWN OF SOUTHOLD : ' BUILDING DEPARTMENT ,'" .... , : - TOWN HALL ' 0 ,',~; "~ "i; >SOUTHOLD, NY 11971 // ' ......................... TEL.: 765-1802 Disapproved a/c ..................................... 3 S~'TS OF ~L.S,~S ......... SURVEY CII~CK .............. APPLICATION FOR BUILDING PERMIT . Date ....... ; .......... , ... INSTRUCTIONS , a. Tiffs 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 stk-eets 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 inspectors on premises and in building for necessary inspectio~ns. ~ (Signature of applicant, or name, if a corporation) oy. /C/z_. % ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If a~ant isa c~or~tion~ignatu~of duly authorize officer. (Na~ ~nd~t~tl~ of co,orate officer) dder s :D~ense No. ~'' ' 9 Plumber's LicenseNo ......................... Electrician's License No ....................... Other Tra, de's License No ...................... , /,~ ' Locati,on ofland on which proposed work will be done. .~J3. . . .C© ~..& ~'~" i CO..~.' ..c~.~.L qJ ' 1. · House Number Street Hamlet Couhty Tax Map No. 1000 Section .............. Block .... /. ' Lot.. / 0 Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) 2: State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existino us~ - t/"~~ [ f--.F--k ~-~ o c ano occupancy...~.Q.'~. /~ ' ' b. lutended use and occupancy . . ,~..~.'.,r~. .~...~.~ ~;% . ; ............ ' · 3 Nature of work (check which ~Pplicable); New Buildin'g Repair Removal Demolition Alteration ' .......... Addition ........ Other Work 4 Estimated Cost (Description) 5 If d ~ it (to be paid on filing this application) f d lli · · welling, numbero we n un s ............. .Numberofdwelhngumtsooeac~ oor ..... i... · If garage, number of cars .... l ................ I fl ....... 6 If business commercial or mixed occupancy specify nature and 7 Ditnensions of existing structm-es if any: Front each type of use extent of. Height Num l:'er .............. of Stories Depth · Dimensions ..of shine structure with alterations or additions: Front ................. Rear Depth ...... : Height ....... i.,.' ........ :..NumberofStories .... ~ ~'i~ ~ ....... 8. D~.mensmns of entire new const?uction: Front ..... ; Rear ............... De _H. ght ......... pth ......... 9 Size of lot: Fro it ................... '. · · Rear ..... De I0. Date of Purchase ..... ; . · ................ pth .................... 1 1 ..................... .'. Name of Former Owner ..... · Zone or use district in which pr~mises are situated ........ ' ....................... 12 " D ~ . ocs proposed construction vio!ate any zoning law, ordinance or regulati 12' Will lot be regraded ........ , ................... Will excess fill be remove o emises: No · Name of Owner of premises ............... Address ................... Phone No ..... ~.' · Name of Architect . ....... i .... · Address Phone No. Name of Contractor ........ i ................... · ......... ·.: .... · Is this property ~ ................. Address ....... ; Ph~N " 15. within 00 feet of a xaa~ wetland? *Yes ........ ' ............ · If yes, Southold Town Trustees Permit may be required. No ......... ... . PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or Proposed, and. indicate all set-back dimensions from property I/nes. Give street and block humber or description accord/ns to deed, and show street names and indicate whether interior or corner lot. 765-1802 9 AM TO 4 PM FOIl THE FOLLOWING INSPECTIONS: I. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 2, ROUGH -' FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST .-~--/IECtO_~.~LETE FOR C~O. ALL CONSTi-ULnTION--$HALL MEET THE REQUIREMENI$ OF THE N.Y. ST^T consmucnon & FOR ==SION O. CONSr.XrCnO. (Nfme of individual signin[ contract[ ....... oemg duly sworn, depose.s ~d says that he is the applicant ,bove named. , . ~ ~ . , · . ' i (Contractor, agent, cor'porate o~fic;r,'e}~.~ .......... ' ............ f said owner or owners, ~d is duly ~uthorized to pcrfom or have perfo~ed the said work and to m~e and file this >plication; that all statemehts contain:ed ~ this application are true to the best of his knowledge and belief; and that the · ork w~l be perfomed in the m~ner sst forth in the application filed therewith. ' worn to before me th~ . ~ ~ Qualifl~ In Suffolk Cou~ y~ ' ' (Signature of applic~t) ~ml~ton ~ires D~ember 8, 19 ~ ' ' ,