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Home My WebLink About21141-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO-N.o ~ll~IZ Permission is hereby granted , .....,......../ ............................. :~). ......... :~ ...... ,~ ....... ~..;.~.~ ......................................... at premises located at ...~./........~....~~,../~...~-~..~. ................................................ Count~ Tox Mop No. 1000 Section ./,,,~...,~,., ...... Block ......... /., ......... Lot No ...... ,/....~., ,.~,,.... pursuant to application dated ........ /.,.,.,~.../.....~... ............................. , 19.~.....~ and approved by the Building Inspector. Rev. 6/30/80 "~OU LJD :' 'BI° 22"7, $"? ff5.'76° f8' OF P~OPEk Y ~,,/EYED FOP-. lIE0 - 4 1992 FOPd'~ NO. '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ...... ' SOUTHOLD, N.Y. 11971 ':"3~%;:'~ O: ~';~)~JTHOLD ,, ! TEL.: 765-1802 Approve ............ I Pemit No.. Disapproved a/c ..................................... ................. ' ............................ ~'''"' '~'''Insp~~~~' APPLICATION FOR BUILDI~ PERMIT BOAKO OF HEALTH /3 SETS OF PLANS ,,/SURVEY ......... CALL ................... ~AIL INSTRUCTIONS g a. This application must be completely filled in by ty~pewriter 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 >r areas, 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 wdrk. 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 luilding 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 all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for necessary~inspections...~.~..~.~.~.~.e.~.? /~r / ' -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame 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) Builder's License No .................. Plumber's License No ......................... ~ El i?ian' Li N '~ ectr s cense o ....................... Other Trade's License No ...................... · Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. lO00 Section .../.~,..,~. Block ' / Lot / Snbdivision ..................................... Filed Mhp No ............... Lot ............... (Name) 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 .~.q'~?.~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .; ........ Repair .... ' .......... Removal ............ Demolition .............. Other Work .g.. ' ~ ' (D n~ti ' ~ ~ ' . esc on) 4. Estimated Cost .... 7 ................................. ~ ..... Fee ................................. . i (to be paid on filing this application) dwelling, number of dwelling' 5. If iunits ............... Number of dwelling units on each floor ................ If garage number of cars . . u. , oumn.ess, commercml or m~xeld occupancy specify nature and extent of each type of use ............ 7 Dimenmons of existing structures if any: FrOnt Height Number of Stories Rear Depth · Dimensions of same structure wlth alterations or additions: Front Rear Depth ~ Height ................................. ! Number of Stories ' ' 8 Dimensions of entire new construction: Front. Rear ~: Height Nurgber of Stories' ' ............................ Depth ............... 9. Size of lot: Front ' Rear ...................... Depth ................ ...... 10. Date of Purchase .. · ........ ' ......... Name of Former Owner .~-.~/.q/q.r?/..~.F/ .[/r.~, .... 11 Z d' ' ' hp~ it · one or use lstrlct in whic r mises are s uated ......... 12 D d i gl · ocs propose construction violate any zen n aw, ordinance, or re u ation: .. ............................ ' 13. Willlot be regraded .... I ...................... 14 Name f O f P ..... , ................... Will excess fill be removed from premises: Yes No · o wnero remises .. ~ · , ................. Address ..... ' .... Phone No ................ Name of Architect .......... i ................. Addregs ................... Phone No. Name of Contractor ........ '~;,',,..~ ..... .. ......~. Address ................... Phone No ................. 15. Is this property within ~uu ~eet or a tidal wetland? *Yes.' ....... No ......... · If yes, Southold T. own Trustees Permit may be required. · .-. 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 coruer lot. .AP, P'ROJ/ED AS NOT£D ' .2_ ':u~OEPART ,v~ IU ~,pM F FC)LLOwI~G ~NSPECT~o~S, OR THE 1. ~()(J~DAT~Oh~ TWO F~[7Oiji~EDr' fO~ pOij[~[D 3. '~SLJL AT',O~ uU~PLETE FOR C.O. ALL CONSTRUCTION 8HALL MEET THE REOuIREMENTS OF THE ~.~ STATE CONSTRU~IoN & ENERGy' CODEs. NOT RESPONSIBLE FOR DESIGN OR CONS~U~IoN ERROR8 ;TATE OF NEW YORK~ ' S S :OUNTy OF... .... , ~' ' ' '.H .... '. ............ z' v ............ , ...... tmame o~ individual signing contract) .bore named· is the (Contractor agent corporate officer etc ) smd owner or owners, ~d is duly ~uthofized to perfom or have perfo~ed the said work and to m~e and file this Pplication; that all statement~ 9~ntain~d ~ this application are true to the best of his knowledge and belief, and that the 'ork will be perfo~ed in t~an~er s~t forth in the application filed therewith. . ' worn to before me this ................. ~/~ .day ~: ~ .q?.~.., 19 ~.~ / ' ........ ' ..................... · .... ....... no. ~%[fY-~tLcl~Y~Z· (Signature of applicant being duly sworn, deposes and says that he is the applicant