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Home My WebLink About20135-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 20135 Z at premises located at ....~..~.../....~........~...~,~ ...~..~..... ............ Co,,nt~ Tax mop ,o. ~000 Sec,on ......... .7...~.... ~,ock ............ ~ ..... ~-ot No ......... .~..,~.,./ pursuant to application doted ...... ~.../~. ...................................... , ]9..,~./., and approved by the Building Inspector. Rev. 6/30/80 0 ?6 ~ i C BLDG, DEPT. TOWN OF ,qOUTHOLD n~ ................... "".?/7. Exami ......... ,19 Approved . '~/r/'~/~'/''( ..........1_,,..9q/Permit No ...... Disapproved a/c ..................................... ............................. .... . O i m f s ootor) APPklCATIOI%I FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTII ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC P 0 R,~! .............. HAIL TO: INSTRUCTIONS " a. This 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 cbmmenced before issuance of Building Permit. 'd. Upon approvai 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, build, in%code, housing lode, and regulat!ons, and to admit authorized inspectors on premises and in building for necessary ....... insp~..~...~......~..s' ,~ ,.-,-- -., 0 P'//h ............ -- ~%(Signature of applicant, or name, if a corporation) ..... I.¢..: ...................... $ ....... (M~Jin~, address of hpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporat~ officer) Builder's License No .......................... Plumber's License No ......................... Electnman s License No ....................... Other Trade's License No ...................... Location of land on widch proposed work will be done ......................... : ....................... '. }'I~e'/'l'ui~t~r ........ ''~J ......... ~ ~r'e~i .............. ~,' ...... I~I;~]'l~i ........... , ............. Subdivision ................... ' Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and in tended use and occupancy of proposed construction: a. Existing use and ' , '' ~ occupancy .............................................. ......................... b. Intended use and occupancy ...................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration..:; . ..,~ .... Repair .............. Rem;vel ........ Demolition .............. Other ~.. ,~7. '.~...~..~.~,.. ' ' ..... Wo.rk 4..Estimated Cost ~..~.O~-J~' ' ' J; 41' ' ~:~(:~.escription) ...... i ............. Fee .......................... :...-.. (to be paid on filing this application) 5. If dwelling, number of dwelling pnits . · If garage, number of .............. Number of dwelling units on each floor ................ cars ..... ; 6. If business, commercial or mixerJ occupancy, spec/fy nature and extent of each type of use ..................... 7. Dimensions of existing structure§ if any: Front .......... Rear .............. Depth Height ............... Number of Stories..; .................. ...... ' .............. iih ............. · ..... Dimensions of same structure w alterations or additions: Front .......... .................. Rear ................. Depth ....... Height ................. Number of Stories .... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Num her of Stories ........................ 9. Size of lot: Front .... Rear ........... ... De ................. pth 10. Date of Purchase ........... ~ ........ · ............. ................. Name of Former Owner 11. Zone or use district in which premises are situated ............... ' ............................ l~t g 1 .................................... 12. Does proposed construction via e any zonin aw, 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 .......... i ................ Address ................... Phon, e No ................ 15. Is this property within 300 feet of a tidal wetland* *v~ No...~N .... · If yes, Southold Tgwn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all Buildings, whether existing or proposed, end. indicate all set-back dimensions from property lines. Give street and block npmber or descriptioh accordflng to deed, and show street names and indicate whethei~ interior or coruer lot. APP,,ROV, ED AS NOTED NOt v 601Z, S,-X 765-I802 9 AM TO 4 PM FOR THE FOLLOWING ~MSPECT~OMS: L FOU~OAT~ON '~O REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE C~PLEIE FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.E STATE CONSTRU~ION & ENERGY CODES. NOT RES~NSlBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK, ,'0 UNTy OF S.S! ' being duly sworn deposes and says that he is the applicant bore named!Name of individual signing kontract) [e is the · (Contractor, agent, corporate officer, etc.) ~ said OWner or owners, and is duly atlthorized to perform or have performed the Said xvork and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ark will be performed in the manner se! forth in the application filed therewith. ~Vorn to before me this .......... i ..... ; ....day of... ........... , 19 ~ ~ ~..~..'~.'.~(Zf0~...'. County [ ,1~ d....~..~ Otary Public ........ :. ~ NOTARY PUBLIC, State of ~eW York · · im'rn Expires March 30,19..~7---0 (Signature of applicant)