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Home My WebLink About20175-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMFF (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N0- 20175 Z Permission is hereby granted to: ...'~..o...X.....~....U ...................................................... ~':'~ -- -~.~.~....~.:.~., ........ LL..~.~..~ ............ to at p~mJse~at~ at ....~.~u ............ ~.~...~.....;...~.~..~ County Tax Map No. 1000 Section ...... ..C~,.~)..g. ...... Block .....,~...~.. ........ -Lot No....~....~. .............. pursuant to application dated ....~..~..,l~clCt..~.....e~.,,~..'~ - ...... 19..~.1.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined .~....[lz~.......,.X~I 19 .~.L Approved ......... .~.~., 19 .~,l. Permit No..'~..~. ! .~..~.~..~" Disapproved a/c ............................. ........ - ......... ' ................: .,,?..,...~...~-~. ~..o/-n~.. ~"~-"')"'~/~' - f/ . ' (Building Inspector) APPLICATION FOR BUILDING PERMIT gOARD OF HEALTH 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORrl .............. CALL~ ...... HAIL TO: Date ', 19 INSTRUCTIONS a. This application must be completely filled in by Wpewr/ter or in ink and submitted to the Building Inspector, with 3 ,e~s 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 ir,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 cbmmanced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit &all 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 liave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding 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. fhe 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 necessaw inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State wbed~er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .................................................. : ........................ Name of owner of premises ~..~.~, .~. ~. ?. ~ ,~. ~ ~} ~ ~... ~ ~ ~. ~ (%~.~)~[p. 0~ .~.[.~ ....... (as on the t~. roll or lates~)~._.7~, ~' ~'~'& o~_~_ ~t' applicant is a corporation, signature of duly authorized officer. F~: ~' ~ .~Y: .~.~.: .... NO'r~FY ~/JtLOING OEPA~ITM[NT AT (Name and title of corporate officer) FOLLOWING Builder's License No...~. ~........ FO, ~OU~E,~' r CO~C,~"-' Plumber's License No ......................... 3. iNSULATION Electrician's License No ....................... OE COMPLETE FOf~ C O ALL CONSTRUCTION SHALL Od~cr Tmde's License No ...................... THE REQUIREMENTS OF THE N ~STATE ~CON~TRUCTION~..& ENERGY t. Location of land on which proposed work will be done..'~'e.~( .~.~ ~. - · - x - ' .... D~SIGMfO~ ~N~T~I~ ~i~O~' ...G. Co ...... .... .... ...... ........... [louse Number Street Hamlet County Tax Map No. 1000 Section .... V.~..' ......... Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) S~ate existing use and occupancy of premises and intended use and occupancy of propoSed.construct on · . [ i tin ano . ....... C.&. ..,., ....... .......... ~ b. lntendeduseandoccupancy......... ................................. . . ... " , ~..~ 3. Nature of work (check which applk able): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition Other Work ~ ~Tx~ c~' " (Desc~ption) 4. Estimated Cost ........ "' 'J' · ~ ...................... Fee ..... (to be paid on filing this application) 5. If dwelling, number of dwelling uniB ............... Number of dwelling units on each floor· · Ifgara, ge, number of cars . ! ............... 6 If business commercial ................................................ ~ ............. · , or mixed o~cupancy specify nature and extent of each type of use ........ 7 Dimensions of existing structures if FrOnt ..................... , any: ............. ~ Rear ' Depth · Height ............... Numbe~ of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~Ieight ............ Number of Stories 8 Dimensions of " ' ....................... · ..................... · entire new construct:ion: Front Rear Height Number of Stories ............................. Depth 9 Size of lot: Front ' Rear · ' ............ r .............................. Depth Date of Purchase ...... ~ ~ · ·. Name of Former Owner .......................... 1 I. Zone or use district in which premises are situated .............................. · ' ' 12. D°es pr°p°sed construction violate any zoning law, ordinance or regulation: ..................... . .............. 13. Will lot be regraded ...... 14 Nam fP ..... ~ ................ Will excess fill he removed from premises: Yes N.o · e of Owner o remises ............ Add · tess ................... Nme of Architect ...... i ....... Phone No .... ............ Address ................... Phone No ................ Name of Contractor. .......... r .............. Address ................... Phone No ................ 15. Is this property within 30Q feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold ToWn Trustees Permit may be required· .. .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prog >sed, end, indicate all set-back dimensions from property Lines. Give street and block number or description according to d~ :ed, and show street names and indicate whether interior or coruer lot. ATE OF NE--~FYC)~[i~:.,~ / I ~- 'OUN-r~ OF~!..~..~... 17', s.~ ...... D .7. ?.c k .f¢ being d ly sworn, deposes and says that he is the applicant (Name of indiv~ual signingJcontrac'ti ....... bore named· 'els the .... ................... .' .j ............................................... (Contractor agent corporate officer etc ) ................. said owner or owners and is duly ~'uthorized to perform or have performed the said work and to make and file this ~p ication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner s6t forth in the application filed therewith. .voru to before me this ' l' , ....... .... ~ ~u~Uo, ~?.Xi,,? ........ .,, ~..~- ~ f.,/// / / _../ ~'""" i ¥ [~;l~jff~e of applicant) 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work 'q~ ~ ..~.'~ ~ (Description) 4. Estimated Cost ......... . ............... Fee ...................................... (to be paid on filing this application) 5. If 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 or'each t e of use 7. Dimensions of existing structures if any' Front ,- YP ..................... H ' -' ............. ~ear .......... eight ............... Number of Stories . Depth ............... Dimensions of same structure with alterations or additions: Front Depth .... ' ................ Rear ..... . . · .. ............. .ne~gnt ................... Number of Stories ...... ' ' ' 8. D~menmons of entire new construction: Front ....... Rear Height ................... Depth ............... ............... Number of Stories... 9. Size of lot: Front ....... ' ................................................... ............... Rear ...................... Depth 10" o 2°fPurch,. s,e. ::" V.': ..... . ................ Name of Fo=er Owner ...... · I I. nv or use (llS[rlc£ In WlllCn premises are situated ............. 12. D°es pr°p°sed c°nstruction violate any 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 buildings, Whether existing or prop,osed, and. indica ~vj~llt~.. sions from property lines. Give street and block number or description according to deed, and show st~.e es and mdicat .whether interior or corner lot. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOW}NG INSPECTIONS; 1. FOUNDATION - TWO REQUIRED t FOR POURED CONCRETE ~ 2. ROUGH ~ FRA~ING .~ PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION/MUST 8E COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION CODES. NOT RESPONSIBLE FOR ~[ ~EStGN OR ~O~,STRUCTIO N,ERRORS r^TE ss 9UN'Ty OF ]~ J,. 0..c~. 1.-% · ...... D. 7. ?,c being dulysworn, deposesand says that he is'theapplicant (Name of indiv~ual signingcontra'cii ...... ore named. is the . (Contractor, agent, corporate officer, etc.) '.,' ' said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this dication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner set forth in tlie application filed therewith· ~m to'before me this -D ..~...~..~a of ~"_ X,-4L ..... //wj 'F~. ,[ ..... y O! ~..~x~.~. .... 19 ?(. / ' (SilEnt of applicant)