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Home My WebLink About20890-z FO~,M NO. II TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER,UT AaUST BE I~EPT ON THE PRE~AISES UI~ITIL FULL COhAPLETIO~q OF THE WORK AUTHORIZED) NO-N? 208~0Z Date //~ 19 .?..'~ Permission is hereby granted to: ................ "~'~'""i ......... ~ ~ :/''' ...... ~.z~.~. · ot premises Iocoted at .......................... :..~.,.~..~ .......... . .~.....~.~......~...~.,.......~...~...~. ................................ ................................................... . County Tax Mop No, 1000 Section .... ~'../...~.. ......... Bl~ck ....... ./..~. ......... Lot No ........ //..~.. .......... pumu~nt to ~pplic~tion ~oted ...................................................... 19..~..~..~.., *nd opproved blt the Building Inspector. Fee $..~....~.. ........ /Building Inspector Rev. 6/30/80 H.A. E~T~4 . ,, ¢074S, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1B0;-~ _ .//~Bt i din,, Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS SURVEY CIIECK SEPTIC FORH CALL NAIL TO: Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets o~' 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 3x arzas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ,hall 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 .hall 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 ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit author/zed inspectorS on.premises and in building_for necessary inspections. -- ~,J ' (Si~,nature of applioEllt, or hattie, if a corporation) ...... (Mailin~ address of applicant) Builder's License No ........................... Plumber's License No ......................... Electri~ian's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .............................................................................. (as on the tax roi1 or latest deed) APPROVED AS NOTED if applicant is a corporation, signature of duly autl~orizcd officer. .............................................. N~i:~P¢ BUILDING DEPARTMENT AT (Name and title of corporate officer) 765-1BO2 9 AM TO 4 PM FOIl THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION il.. FINAL CONS'fRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. · Location of land on which proposed work will be done ...................... ~.'r,ATE...C.O,N.S.T,R. qC.T.I.O.N..&...E.N,E.R.G? llouse Number Street Hamlet County Tax Map No. 1000 Section ....... ././."~... ...... Block /r/ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) · State existing u~ and occupancy of ~remises and intended use and occupancy of proposed construction: b. Intended use and occupancy . ¢~.~ .~ .~..¢?~..~4 ~... ~4¢&~ ~ 7. ~... ~ .......... vork (check which appticable): New Building .......... Addition .......... Alteration .......... ', .......... Removal .............. Demolition .............. Other Work ............... '." f~..~. . ~f ~ ~, (Description) '. ' ., Cost . Fee . . f~-~;> (to be paid on filing this application) ., dwelling, number of dwelling units ............... 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ............... . ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............................................. ; .......... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............... : ....· ......... Name of Former Owner ............................. I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate ~ny zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ 15. property lines. Give street and block number or description according to deed, and show street names and interior or corner lot. , , Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .............. .~r... Phone No .............. ,.. Is this property within 300 feet of a tidal wetland? *Yes.. ~¢~.... No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from indicate whether STATE OF NEW YO~ COUNTY OF ........---]~."~,kYw.. S.S ......... .~?.~..~.....~......,~..~..M~.L./..-f/(".~,.~. ........... being duly sworn, deposes and says that he is the applica, (Name of individual signing contract) above named. '~'[e is the ....................... · .~. · · · .*"~. · ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl application; that all statements contained in this application are true to the best of his knowledge and belief; and that t work wi/1 be performed in the manner set forth in the application filed therewith. Sworn to before me this ............ ~ .2..-~...~/..~day~ of~) .... :.., 19,9,2,- /,I ' ....... > ............................