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HomeMy WebLinkAbout20197-z IPOZZM_ lqO, 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20197 Z · ./o Date ........ /.~.. ...................................... 19...~/ Permission is hereby granted to: _ . ..~~~.,.~.~. ........... ././.~.~ ,o .~~ ..... .~i....~..~iii~. .... ~~. ..... ~~~~.~ ................ at premises ,~at~ at..~.~ ~ ..... ~~. ~/ ......................... ~~~ ..................... cou,~ T~x ~,p No. ~0o0 Section ..~ ............... m~k ...~..~ ............ Lot No. /' / ~ Building Inspector. Fee $... ~..~ Rev. 6/30/80 · MOORE'S NIO/F JOHN A. COSTELLO CEDARFIELDS DRIVE LANE ~44.~~ Exami!lq FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... . (Buil, dingz~ector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORH .............. MAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 iets 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 Dr areas, and giving a detailed description of layout of property must be drawn on tile diagram which is part of this appli- ration. c. The work covered by this applica{{on may not be c})mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ;hail 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. file applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and :dmit authorized inspectors on premises and in building for necessa~sq-nspeq,tions. -- (Signature of applicant, or name, if a c~rporation) ..... u.V, 'l l~(~ing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O.. c) e C: · Name of owner of premises. [..~...(~..f~ i.~..[ . . .~.....~...~l.~..~'.~....0.(?...V~...t~..i} 0. 5f ....... i ............. (as on the t.a~x 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 ......................... Electrician's License No ....................... Other'Trade's License No ...................... Location of land on which proposed work will be done_ ................................... , ' . . t .o. ................ : ...... ¢ ,: ....... llouse NumberStreet ............ 90 County Tax Map No. I000 Section .................. Block ............. ". .... Lot ............. Subdivision ..................................... Filed Map No ................ Lot ...... ·. ........ (Name) ' · State existing use and occupancy of~emises and/intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~ .~.~..(...~. ?.Ft. ?..~. ............................ b. Intended use and occupancy ................................... .., ,. 3. Nature of work (check which apiphcable): New Building .......... Addition .......... Alterat~ .......... Repair .............. Removal .............. Demolition ......... Other Work..~.'.~ .C,.I~.. (Description) I (to be paid on filing this application) 5. If dwelling, number ' ~ · of dwelhng umts ............... 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 structure~, if any: Front ............... Rear .............. Depth ............... Height .............. Number of Stories ...................... f i~h It dditi .................................. Dimensions o same structure w a era[ions or a ons: Front Depth .... ~ ............... ' ............... ~ Rear .................. ................ ·. Height ... . ·.. Number of Stories ...................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............ Height ............... Number of Stories 9. Size of lot: Front ........... ~ .......... Rear ...................... .D_.~pth . .-n-, ..... t ......... 10. Date of Purchase . .~[.~.~fl~ i~../ ]c~ '' Zone or use district in which pre' ises are situated ......................... 12. Does proposed construction violam ........................... te any zoning law, ordinance or regulation: ... ~1~ ....................... 13. Will lot be regraded ......... i .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ... i ................ Address ................... Phone No ................ Name of Architect .......... , ................ Address ................... Phone No ................ Name of Contractor ......... ; ................ Address ................... Phone~blo ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.t'~ ...... · If yes, SouthOld Town Trustees Permit m~y be required. PLOT DIAGRA~ Locate clearly and distinctly all property lines. Give street and block interior or coruer lot. bu!ldings, whether existing or proposed, and. indicate ali set-back dimensions from umber or descriptioh according to deed, and show street names and indicate whether 'TfilB,'~80,~ 9 AM TO ~'~ PM FOR THE FOLLOWING INSPECTIONS: "t. FOUNDATION fWO REQUIRED FOR POIJRfSD C[)NCRI~TI~ 2. g~OtJGH .. FRAMING & PLUMBING 3. INSULATION 4 FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE r~IEQUIREMENTS OF THE N.Y'. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK, :OU~FY OF S.S (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant bore named, i is tile,' (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 ;~plication;. that all statements~ . contained in this application are true to the best of his knowledge and belief; and that the 'ork w,l be performe~l ]n {.he manner set, forth in the application filed therewith. woru to before me [his ! ........... .--,... day of.. ~ m , ..... Otary Public, .. < i. Co . , Jo¥cE M. 1. · , Sutlalk qa~unt~ (Signature of applicant) Term Expirel June I,~ 1~