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Home My WebLink About21198-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NgNo, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21198 Z Date ...././, .~.,.~ ....................................... , 19..~....~ Permission is hereby grant.ed to: ,~ ~ ~'/ /~ ~~.'""~...~ ~'~-~-' .~ .......... ~..~-~,~~. ~ pursuant to application doted ....... ~/..//..~.. .................................. , 10.~, and approved by the Building Inspector. Fee $..~......~....~.. Rev. 6/30/80 {~' . o?' oo'oo' · ~OOJ~' ~ t,~o0.O0' sMITH ROAD (privQte r oaCl'~ N 07' 00'00' ~ 0 ,5, Z Z 0 1,3gO,O0' iz~: O< MAP OF' ARROWHEAD cOVE FILE # 3810 N 07' 00'00" W 10048' ,~, r' 0 ~o io0,00' RoAD Z3' o0" E h4oo.oo' ~0~< ~Do ,'i ~ JN'I I 9 ~ , .o.. No. 1 TQWN OF SOUTHOLD ..,; ..... B~JILD NG DEPARTMENT ,'~ )~'*. *~; r t, T,q~^/r~ HALL ....... ; :'~OU~HOLD, N.Y. 11971 ' TEL.: 765-1802 Examined ~ ~ , , 19~ Disapproved a/c ..................................... . ~Building I~ector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............. B SETS OF PLANS ...... ~. ..... ~URVEY "' p/CHECK ...................... SEPTIC FORM ................ NOTIFY ....... 19 INSTRUCTIONS 'a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building ]~nspector, 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 streets or areas, and giving a detailed description of l~yout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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, ¢. No building shall be occupied or used in whole orin part for agy purpose wt~atever 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 pursuantlto the Building Zone Or~lina'nce;Ofithe Town of Southold, Suffolk County, New York, and other applicable Lasvs, Ordinances or Regulations, icl' the construction of buildings, ad~ditions or alterations or for removal or demolition, as herein described. The app ic~ht a~rees to comply wi~h all applicable laws, ordinances, building code, housin; code, and regulations, and to admit authorized inspectors on prem'ises and in building for necessary inspections. . (Signature. p~pplicant, or name, if.i} corporation) . (Mailing address of applicant) 1-~ c~ .~, t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameof0wnerdfpremises .. ..o,,f-:..~....~. ~ .:N. iO..~-.5.,_~. : ' ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...l..~.;~il, .O../...4W.[ ~-,....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ......... ' ' .... ................. ......................................... tlouse Number Street, Hamlet County Tax Map No. 1000 Sectioo . .~ .~ ~. ....... 2 Block .~.~ ....... Lot...~. ~. .......... Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) State ex~stmg use and occupancy of premises and intended use and occupancy of proposed constrnction: 3. ature of work (check whic,h;[applicable): New Building ..... ' ..... Addition .......... Alteration ........ Repair .............. R,~moval .............. Demolitidn ,.V~. [ {4~[~ . Other Work .~..~.~Q~..... ' (D rip ) 4. Estimat DSt ../.~:m.~.~.~ ............. Fee /~._.~" ' (to be paid filing this application) 5 If dwelling number of dwelling units on Number of dwelling units each floor ' If garage, number of cars ...[ .................. · ........... 6 If business commercial or mixed occupancy spccil .................................................. · ' 'y nature and extent of each type of use 7 Dimensions of existing structqres if any: Fr'~ on(. ....... Height NUm der of Stories .. ............. Rear ................ Depth .............. of same structure lwith alterations or additions: Front Rear Depth .................. i ....Height ....................... · 8 Dimensions of entire new construction: ...................... Number of Stories ...... ' .......... · Front Rear Depth ............... Height Number of Stories Size of lot: Front ' · ......... ? ............ Rear ......... Depth 10 Date of Purchase ................................. · · ........ i ................... Name of Former Owner ............................ 11. Zone or use district in which ~remises are situated ........................................ Does proposed construction violate any zoning law, ordinance or regular ~ ............ 12. ion: .... m ...................... 13, Will lot be regraded . NN~: oO[ AOrWc;7;oc[ p.r/e.~. :! ;.~.' ................... Will excess fill be removed from premises: Yea Nc ~ ~ Y xoq:ateo w~t]~in~O0 feet of a tidal wetl'[hd? ~YES ...NO .... · If yes, Southold To~n Trustees Permit may be required· .·. ! PLOT DIAGRAM Locate clearly and distinctly ~I buildings, whether existing or proposed, and. indicate all set-back dimensions frorr property lines. Give street and block number or description according to deed, and show street names and indicate whethe: interior or comer lot. / ¥ STATE OF NEW YORK, COUNTY OF ................. ;.S (Name .... ' .................. of individual s~gni!~g contract) above named. , " APPROVED AS NOTED ' DA'rE: ND~I~ BUILtflh]G'~aOEPART-M'E, NT AT 765-1802 9 AM ~ ~.PM FOR THE FOLLOWING INSPECTIONS: 1. fiOUNDATtON - ~O REQLqRED FOR POURED CONCRETE 2. ROUGH - FRAMING ~ PLUMBING 3. INSULATION 4. FINAL CONSI'RUCT~ON MUST 8E COMPLETE FOR C,O. ALL CONSTRUCTION SHA~ MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONBTRU~ION ERRORS being duly sxvom, deposes and says that he is the applicant He is the .............. i (Contractor, agent, corpor~te officer, etc.) of said owner or owners, and is dulyI authorized to pe~rform or have performed the said work and to make and file this application; that all gtatements contaiped in this applic~,tion are true to the best of his knowledge and belief; and that the Work will be perforated in the m~ner ~et forth in the appl cation ~lcd therewitlL Sworn to before me this ' ......... ..... ...... or.I. · ...... ~W ~bl~ ~ ~ ~ ~ · ~~. (Signature of applicant)