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Home My WebLink About21006-z I~Ou.'M' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING P£RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N? 2100SZ Permission is hereby granted to: . .,., ~...~.~.....~...~/...-. ................. . ...../.~,...'.~;~:;.~. ............................. ......... .... County Tax Map No. 1000 Section .......... Block ........ ~ ....... Lot No ............ pursuant to application dated .....*~.~- ./..~ ................................. , 19..~......~, and approved by the / Building Inspector. Fee Rev. 6/30/80 FORM NO. 1 [-)~"[ - ~t.~'¢~':'¥ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. APPLICAT4'ON FC~ BU:LDING PF. RIM[T Da~e .. , 197.. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 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 ispued 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 inspection~ ~ , ................ --' : (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applican~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~4./?.... .~...t4g.. (.¢..~.~...~.~ Name of owner of premises .~. ~.,.,~.-/....~.. ....... ................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber s License No..~ ............. Electriqian's L/cens~ ...... ~ ........... OtherTrade'sLicenseNo............r " ~ ......... 1. Location of land on which proposed work will be'done ........................... ~ ...................... ....... .o. ........... ....... .47. A. ................... House Number Street ' Hamlet County Tax Map No. I000 Section .... Block ...... Lot.. Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) L State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~....e.~...~ '~ f/,~ /70 J....J ~ ..... ' ,:,,: ,. ;t,."',~. ,-, ....... b Intended use and occupancy' . ' ' ' 4. Estimated Cost ........... i ........ 5. If dwelling, number of dwelling units ............ If garage number of cars' Nature of work (check which applic'able): New Building .......... Addition .......... Alteratir~n .......... Repa/r .............. Removalj .............. Demolition ............. Other Work t~.,~q~, l~t.~.. .... (Description) ........ Fee .... .o~...~... ........................... (to be paid on filing this application) ·, Number of dwelling units on each floor ................ 6 If business commercial or mixed occupancy specify .................................................. · , , nature and extent of each type of use ..................... 7. Dimensions of existing structures, any Front. ;.'~,', : "Rear ... ~" ........... Depth ........ Height Number' of Stories Dimensions ofs tructu with ~lt ationso addition F Rear ames re er r s: runt ............... . . , Depth Height ~ Num bur of Stories 8. Dimensions of entire new construcfion: Front Rear Depth Height ............... Number of Stories 9 Size of lot: Front ~ , ;'Rear .'.. ' Depth 10 Date of Purchase i Name of Former Owner ...................... 11. Zone or use district in which premises ~re situated 12. Does proposed construction violate~;/ny zoning law, ordinance or regulation: ................................ Will lot be regraded .... ' · - ..... W'II excess 13 ...... ~ · k .? ..... ~',. ;~t Illl De remoVeu trom premises: Yes No 14. Name of Owner of premises ,~.~, ~'~.~. ~.~: .~..~..~..".°A'-d'~ress J,g~./.~../;.~..,~O...~..t2...~l~-~one No. ,:~ Name of Architect ~ Address Phone No Name of Contractor .......... · · ! .............. Address ................... Phone No ................ 15. Is this property within 3001 feet of a tidal wetland? *Yes ........ No..~.. .... · If yes, Southold Teyn Trustees Permit may be required. PLOT DIAGRAM Locat.e, clearly and distinctly all bt~ildings, 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 stree~t~l~J~l~[~][~l)whether interior or corner lot. , ~ /..~/~ ~ ,,, ~/~. DATE; ~ B.R # ' FEE:~BY: ~ . NOTIFY BUILDING DEPARTt~ERT AT 765-t802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONSi,, 1. FOUNDATION - TWO I~EOUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING ~& PLUMBING 3. INSULATION , / ' 4. I:INAL - CON~IYRUCTION MUST BE COMPLETE FOR C.O. AL ~ CONSTRUCTION SHALL MEET E REQUIREMENTS OF THE N.Y.. ~TE CONSTRUCTION & ENERGY DES. NOT RESPONSIBLE FOR SIGN OR CONSTRUCTION ERRORS TH ST STATE OF NE~'gK~ .......... being duly sworn, deposes and says that he is the applicant [te is the ............ (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly ~uthorized to perform or have performed the said work and to m~e and file this ~pplication; that all statements conta n~d ~ this application are true to the best of his knowledge and belief; and that the ,york will be perfumed m t e manner set forth in the application filed therewith. ¢wom to before me this ............... day of. [ ..... 9 ota~ Public,. Qualified In Suff~k ~u~ ~ ~' (Signature of applicant)