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Home My WebLink About21190-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH HALL $OUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 21190 Z Permission is hereby granted to: ..... ...... ................... at premises I~ated at .............................. ~ .............. ;; ..................................................................... ................... ~~ co..~ ~ ~ No. ~000 s~:.o. ..... ~C .......... m~ ....~ ........... ~o~ No ......... .~ ......... pu~uont to application dat~ ~-~ 19.~.., and opprov~ ~ the Buildin~ Inspector. 6/30/80 ND T~ : · ~ MONUMENT YOUNG & YOUNG FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 .t ,or :x.'xB~..d, mg Inspector) APPLICATION FOR BUILDING PERMIT §OARD OF HEALTH ......... 3 SETS OF FL.~.?.{S .......... SURVEY CIIECK ....... NOTI FY ~ CALL ................... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter orin 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, 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. e. 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 hvailable 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 ;hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu?l'ding Permit pursuant to the 3uilding 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,4e/~oval or demoli~on, as herein described. the applicant agrees to comply with all applicable laws, ordinances, bu'fldin~/l!/)de, housing ~ocl~, and re~lations, and to admit authorized inspectors on premises and in building for necessary ~ ~4~% ' .. :-- (S.~gi~nature of applicant, or n_ame, if a corporation) .. · ....,..2 ¢.,. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · . . X/amc of owner o f premises--',-)F~..-'.~........,~..~y~-- ~ ....... ........ : ' ' ','nam '//??,~3' ~'~ ~':z~//¢~ ~ (as on the tax roll or latest [f applicant is a corporation, signature of duly authorized officer. ~*)~F~/' BUILDING ~PAffi'MENT"- r ~ ~AT 765-1802 9 AM '10 4 PM FOR THE (Name and title of corporate officer) ~ FOLLOWING INSPECTIONS~ 1, FOUNDATION TWO REQUIRED FOR POURED CONCRETE Builder's License No .......................... ~ 2~ ROUGH - FP~MING & PLUMBING 3. INSULATION Plumber's License No ......................... : 4, FINAL CONSTRUCT,"ON MUST Electric, Jan's License No. , _ I~E COMPLETE FOR C.O, ...................... ALL CONSTRUCTION SHAll. ~IEET THE REQUIREMENT~ OF THE N.Y. Other Trade's License No " STATE CONSTRUCTION & ENERGY . ". CODES. NOT RESPONSIBLE FOR · Location of land on which proposed work will be' done .......... '"'"....-....-..................DESIGNORCONSTRUCTIONE.RR.O.R.S.. . ...... ......... .... .... ......................... House Number Street Hamlet County Tax Map No. 1000 Section 5 ~'~ DC ' "~ ot ~ ~'~ .................. BI k L Subdivision · Filed Mhp No Lot ' (Name) State existing use and occupancy of premises and intended use and occupancy of proposed cohstruction: a. x,s,,ng .se and occupancy .... b. Intended use and occupancy .................... 3. Nature of work (check which ' ' ~pphcable): New Building .......... Addition ....... '. · · Alteratio, ve-. Repair .............. Removal .............. ' ........ .~ Demolition .............. Other Work . . ~i~.. .... 4. Estimated Cos ........ ~,...!.. ~ ~ [ ~Description) , (to be paid on filing this application) 5. If dwelling, number of dwellin units .......... Number of dwelling units on each floor ...... · Ifgarage, number of cars ................... ii'" ' ......... 6. If business, commercial or mix occupancy s~ecif ture an t o ..... ~ _ y na d exten f ........... ~ '' 7. D~mensmnsotemstmgstructur s, ifany: Front ........... Rear .............. De ........ Height ............... Number of Stories ................... pth ...... With .............................. Dimensions of same structure alterations or additions: Front .... Depth k Height ................. Rear ................. ................... ' ........................ Number of Stories 8 Dimensions of entire new construction: Front Rear ' Height Number of Stories .............................. Depth ............... 9 Size ofl ;: ............. I ...................................................... Front . · · ......... , ........... Rear I0 Date of Purchase ~ .................. Depth ...................... · Name of Former Owner 11 Zone or use district in which pr~mises are situated ............................. 12. D°es pr°p°sed construction vio]ate any zoning law, ordinance or regulation .... 13. Will lot be regraded . . . i · , : ............................ x~_ ~ ^ o ' .' · · .; ................... wm excess fill be removed from premises: Yes No 14. ,~ame m ~wner ol premises ............ Address ~- I .... · .................. Vnone iNo Name of Architect .......... , ................. Address ... . Phone No. Name of Contractor ..... !.. ' ............................. ................... Address .... ~ · · · Phone No. .. :. 300 ...................... 15. TS th±s property w~.t:h~n feet of a t:±dal wetland? eyes.' ....... No ........ · 'cf yes, Southo~d Town Trustees Perm±t may be requ±red. ' '". i PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or comer lot. :ou rv s. · (Name of individual signingjcontract) being duly sworn, deposes and says that he is the applicant bore named· ' , - is the - l ! (Contr~.q_to~orporate officer, etc ) ............ said owner or owners, and is duly a~thorized to perfo~ or have pcrfo~ed the said work and to m~e and file this ~plication; that all statements containeH ~ this application are true to the best of his knowledge and belief; and that the ork will be perfo~ed in the m~ner se~ forth in the application filed therewith. t° b'e~r'~ T/t' ~"day ° f ~/~,19~ -- ' ' · ' . " ' . ........ o)k ~u~ ~ ' ( 'g of applicant)