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Home My WebLink About20774-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Ct'HIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~N? 2077JZ Permission is hereby granted to: ...~:ll,;~...~..ff~ ....... ~.~. ........ ..~.~....~..~. .~.....~......,~..~ ....... d~... ....... ..~.~.,~.~:.,~..~......~ ...... ~...~??~ .... ../..,. ....... ~. ................................................. ~. ............................................................................ ~... at premises located at ...ff,.?.~....J.~... ............ ,.~.:..'~.~....d~.....~........~. ....................................................... ............................... . .~..~.~~. ~... ........................ County Tax Map No. 1000 Section .... ./.././.. ............ Block .....~.~.. ............ Lot No ......... .~../.. ......... pursuant to application dated ................. ~ ........................., 19..~and approved by the Building Inspector. Rev. 6/30/80 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............... : ....· ......... Name of Former Owner ............................. 11. 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 ................ Name of Architect ........................... Address ................... Phone No ........ Name of Contractor .......................... Address . Phone No. iiiiiii ....... } 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... } *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distin6tly all buildings, 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 street names and indicate whether interior or comer lot. STATE OF NF_~YO, R.~'~._ /]~ S S COUNTY Ot,F . .'~.-X4~...I. ~ ((.X. ' ........ · ~'.L/.//. (5~.k~[~, .~..~.~/. .... ' ........ being (Name of individual signin~ontract) aboye named. duly sworn, dePoses and says that he is the applicant JUN 2 61 ,2 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .......... 19 Approved ..... ...... l g.¢. .ee itNo. Disapproved a/c ..................................... . . ~¢ildin~ Inspector) . A~PPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PL,%NS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. Date .................. , 19... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter 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 is?ued a Building Permit to the applicant. Such permit shall b~ kept on the promises 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, jand regulations, and to admit authorized inspectors on premises and in building for necessary inspqctions. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ............................. P RO' tO'AS j ..... Nameofownerofpremises...... ...... ~////.~fi~ ..~....~.~..~..'~... . ... .~.~...~..~.'...Oh~lE:~.lt.B-.~~ (as on the tax roll or latest ~ .EM!¢~'7',<¢~ BY: -~ N~J'fIFY BUlL.DING D~PART~/IENT-AT If applicant is a corporation, signature of duly auth~orized officer. 't65~1802 9 AM 4 PM FOR THE · '#OLLOWING INSPECTIONS: (Name and title of corporate officer) t, FOUNDATION ~ TWO REQUIRED FOR POURED CONCRETE Builder's License No .... .C~..O4 ./~ff...'~,. ............ 2, ROUGH - FRAMING & PLUMBLNG Plumber's License No ......................... 4. FINAL CONSTF~UCTION MUST BE COMPLETE FOR C,O. Electrician's License No. ALL CONSTRUCTION SHALL MEET ...................... THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR Location of land on which proposed work will be' done. /~r~ .I~ I//~ ,. "~-DESI~I~OR CONSTRUCTION ERRORS ........... y.~../~./. ,o..~....:,. f,&' ....................... llouse Number Street Hamlet County Tax Map No. 1000 Section /! I ....... Block .~ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy (~' ~./~' ~,e ~rS~ ,rA,'c' ~c- b. Intended use and occupancy ~ w- ......... ~ ~ 3. Nature ofw~eck which applicable): New Building .......... Addition ~ Repair ... ~ ....... Removal .............. Demolition ......... ' ........ Alteration ............ (Description) 4. Estimated Cost ........... ~;~q~. ................... Fee ..................................... (to be paid on filing this application) $. we ~ng, numbero welhn.umts ............... umberofdwe ngunitsoneac floor ............... . If garage number of cars 6. If business, commerciai 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 samestmcture with. alterations or additions: Front .... .... · . ...... . Rear ................ . . Height Number of Stories ~ Depth .................... ....................................... , ....... 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 .......................... l 1. Zone or use district in which premises are situated 12. Does proposed construction vio!ate tiny 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 ................ Name of Architect .......... ................. Address ................... Phone No ................ ~ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing o~ proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ' STATE OF N~ORK~'~.~ / / COUNTY OF'[~~ (.~,. S.S .........P.V / ..... ' ........ (Name of individual signii~dontract) above named. being duly sworn, deposes and says that he is the applicant He is the . I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly lauthonzed to perform or have performed the said work and to make and file this application; that all statements contaifled in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner $et forth in the application filed therewith· Sworn to before me this ~ ~ .. County ,' - Quallf~ In Surfak C~