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Home My WebLink About21016-z I~ORM NO. ~ TOWN OF $O~THOLD BUILDING DEPARTMF. NT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N"_N? ~1011IZ Permission is hereby granted to: ......... ..?.x..,.'.~. ~ .....~ ............................. ...............................-~ ~..,,' ~ ., .~..,.~.....~.~ ..................... ~ , :..../../.~.~._.~.. ....... ~ ~¢ .~ . ~/--,'~x .ZE...~..~.. ..Z~....~.~ I..../j/~.~ ..... to ......C~.,..;~ ...... ~ ............... ~ ...................... ./., ............................................. .....(..~ ............ ~../.~:~.~..........~..~: .................................................................................................. at premises located at ........................................................... ......................... ............ ................................... ......¢ .............................................. Ca~ To× Uap No. ~000 Sect~o~ .../.a.~ ......... ~ock ..... ~ ......... Lot Ua ..... ....~..:...~./.... ~,,o~t to op~,¢ot,o~ dat~ ........ ./.~/.~ ................................. ~,..72...~ and ~pro~ Building Inspector. Fee $ ........................ /BuiEIing Insi:mctor Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... ocr - . fiBuilding Inspector) APPLICATION FOR BUILDING PERMIT Date. ?&.'.77.. ff. ........ 19q~. BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... ClIECK .................... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 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 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 inspections~_ --' (Signature of applicant, chename, if a corporation) ?: (Mailing address of applicant) ' '~//~5~ ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,' plumber or builder. ... ?.. ~.~-&'c.5. . . .ff :.s. ~.~. . ............ i ..... . ........................... ~PPROVED ~ NOTED ....... Name of owner of premises .~.e~'//* W'~ P~/~'~; DA..TE: ~,:p.. # ........... If applicant is a corporation, signature of duly auth~orized officer. 765-1802 9 AM TO 4 PM FOR THE S:OLt. OWING INSPECTIONS: (Name and title of corporate officer) 1, gOUNDAT}Oi'~ 'BNO REQUIRED FOR POURED CONCRETE 2. ROUGH- FRAMING & PLUMBING Builder's License No ..... q N&e.~ ............. 4. ¢INAL CONSTRUCTION MUST Plumber's License No ......................... IBE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET Electrician's License No ....................... THE RE~QUIREMENT5 OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR 9ESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be'done .................................................. House Number Street Hamlet CountyNo. 1000 Section../.--q.5 .......... Block Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................ b Intended use and occupancy aplplicable)' F.~. ?.~..~. 3. Nature of work (check which New Building .......... Addition · Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... ___ ~' ' .~. ~..~. ~ (Description) 4. Estimated Cost ...................... Fee I (to be paid on filing this application) k 5. If dwelling, number of dwelling 0nits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~,, if any: Front ............... Rear .............. Depth ............... Height ............... Numiber of Stories ........................................................ Dimensions of same structure wilth alterations or additions: Front ................. Rear .................. Depth .................... ].. Height ...................... Number of Stories .............. ~. ....... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth ............... Height ............... Num)er of Stories ........................................................ 9. Size of lot: Front ...........i ........... Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violhte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i ................... .Will excess fill be removed from premises: Yes No 14 Name of Owner of premises Address Phone No Name of Architect .......... [ ................. Address ................... Phone No ................ Name of Contractor ......... ! ................. Address ................... Ph No... 15. Is this property within ~00 feet of a tidal wetland? *Yes ........ °1~ ............. · If yes, Southold ~own Trustees Permit may be required. PLOT DIAGRAM Locate cleariy 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 corner lot. STATE OF NEWfffO/I~.,/./~ el o , COUNyY OF ~K~_ ..... (Name of indiOtdual signing contract) above named. He is the ....... i .................................................................. ~ (Contractor agent corporate officer etc ) ~ owner or owners, and is dulyiauthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner iet forth in the application filed therewith. Sworn to before me this ' .............. .~ay of.' ....... 19. ry Public ............. ~ .... County ....---&_ ' EDW. EV. MU LE. /, t) NOTARY PUBLIC, StateI of New York ~'~' ' No 4895193 Qualified in Suffolk County.... ~ ,~ Commission Expires M?y 26, I :? t~te. 25 ) AT M4~I~UCK SUFFOLK COUNTY, NEW