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Home My WebLink About21173-z IPOR~d[ NO. 0 TOWN OF SO~THOLD IUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to:, ,~, ....... ,.~,... "~ -..g~.~.~ .... ~ .... ~..~....~..~. ............................. '..~~ , , .... ~.~.~../.,....,?:~- .............. : .............. at premises located at ......~..~.~.........~.,~....C.....~.~..........~.,...Z~......~... ................................................... County Tox Map No. 1000 Section ......... ~...~.. ........ Block ......... ./.. ......... Lot No ......... ./..~..~.....~... pursuant to opplication dated .... ../.....-~.../..~..~.. .............................. , 19...~....'~'., and approved by the Building Inspector. Fee $.~......~..K/~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOAaD OF HEALTH SETS OF PLA~tS .......... C./~u~vEY ................... a4:llcca ........ ./..ff..~, . TEL.:,765-1803 t;oT I,F¥; ............... Examined . 19 ~;~..~ Approved 19 Pe~it Disapproved a/c ..................................... ....... (~ilding Inspecto~ INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets o£ plans, accurate plot plan to scale. Fee according to schedule. Il. Plot plan showing location of lot and of buildings on premises, relatior~/ship to adjoining premises or public streets 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 b~c£ore issuance of Building Permit. d. Upon approval of this application, the Building Inspector wiJl issued a Building Permit to the applicant. Such permit sh~l be kept on the premises available for inspection throughout the work. c. 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 compiy with ail appHc=ble laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premhes' a/Id in building for necess,ary inspec[ions., (Signature of appl~'fT~r name, if a corporation) ............. '/' ........ ~;",d,:,.~-~,~i · :',= · ',~ ......... (Mailing address of'~Sif6a~ State whether applicant is owner, lessee, agent, architect, engineer, general contragtor, electrician, plumber or builder. N · amc of owner of premises .~....*.x.~~./~.... ~ .~ ................................... ('-'~s on the. tax roll or latest deed) ' [f ~ppl{cant is a corporation, signature of duly auth~orized'-6fficer. (Name and title of corporate officer) Builder's License No ....................... Plumber's License No ......................... ; Electrician's License No ................. '. 7- .... Other *rade's icense No ...................... · Location of land on which proposed work will be'don~. ~.~/./~ ~,. ~'. ~. ] .... ~. ~..O.~. ~. ~.~.~'. House Number Street ', H~I~ ..... r~'~' County Tax Map No. , 000 Section ..... ~.. Block' { Lot /~ ... Subdivision Filed Mhp No Lot (Nam9) State existing use and occupancy of premises~d intended use and occupancy of proposed construction: =.and ............ . ...... b. Intended use and occupancy ................ ~ .' ~:?i' v,'~;" ~ ~ ~. '.,: .-," 3. Natu.re of work (check which a~plicable): New Building . . . Addition ' Alteration Repan' ......... Removal ...... Dem-'~;*;,- ' .... ','~ ;' ' -- ' - ' ' ' ~-: ~" ........ ' ' . I .' ........... n ........... uther Work ' ,~'-.~[r ~ ~./~. 4. EstimatedCost...t'.e.~.'O.~.o,.~:4 ....................... '. Fee ...... $ If dwelling number I (to be paid on filing this application) · , of dwelling units ............... Number of dwelling units each floor If garage number of cars ~ on ................ If business, commercial or mixed occupancy specify nature and extent of each typ~ of use 7 Dimensions of existing structflr~s if any: FrOnt Rear Height Number of Stories ............................. Depth ............... Dimensions of same structure with alterations ..................................... Depth Height or additions: Front Rear ................... "' · ................. Number of Stories 8 Dimensions of entire new constraction: Front .... ' Rear Depth Height Num!ber of Stories ............................................. 9. ~ze of lot. Front ~. . ~ .... ......... ....... epth . . ,, 10. Date 0£ Purt, hu~ · ............ D .......................... , .... .... ........... ~i i'si i~dl i e rmerO... · · wner.. ............................ 11.' Zone or use d~stnct m which pre scs ar tua. te any zoninr, lnw ~-~:--- ° ' ' ',' '. .................................... 12. Does proposed construction violat ..... o .--- ummunce or regulation. ,. 13. Will lot be regraded .... ' ..................... ........................ wm excess fill be removed from premises: Yes No 14. Name of Owner of premises ... i ..... Address Phone No. Name of Architect ! ..................... .......... ~ ................ Address ................... Phone No. Name of Contractor ......... , ................ Address ................... Phone No .............. '.. 15. Is this property within 300 feet of a tidal wetland? *Yes.' ....... No ......... : · If yes, Southold T~wn 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 block number or description according to deed, and show street names and indicate whether interior or comer lot. AP O,V ED AS BOTED NOTIFY -BtJ~l~iN~- 7~4802 ~ AM ~ 4 P~Ofl THE FOLLOWIN~ INSPECTIONS: I. FOUNDATIO~ ~O REQUIRED FOR .POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSU[ATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR' DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEgL,YOP~tO t//~ ,,., :ou ry OF. g Ta/4 .. ....... (Name ofind,vicrual signing icontrae'ti .......... being duly sworn, deposes and says that he is the applicant bore named. ' . . ( Ontractor agent corporate officer ere ) .......... f said owner or owners, and is duly authorized to perform or have performed the said Work and to make and file this ~plication; that all statements containeO in this applicat on are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the appliqation filed therewith. worn to before me thi~,x,_~ . ~ ............ .... . _ .i ' Notllry Publio, state of New Yo~ No. 4879E05 i~ ~ t gnat re o[appncant) Ou,,.,.d ,. su., k Commission EXPlre~ Dee. ember 8,