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Home My WebLink About20204-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 20204 Z Permission is hereby grant~,d to: ..... ~:...~...?~.......~....~ .................. ,o...~/~......~...~...-'..~...~.~...~......~....~ ....... ~~ .~...~ ..................................................... at premises located at ..~.,..~......~.,.-~,...i~~..~./, ................................................ County Tax Map No. 1000 Section ......... .~..~... ....... Block ....~ ............. Lot No ......./...(? ............ pursuant to application dated ........ ../...~....~../.. .............................. , 19....~./, and approved by the Building Inspector. Fee $...~...~.~.. Rev. 6/30/80 Disapproved a/c ............. , ........................ . ~ulldi~nscector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHQLD, N.Y. 11971 BOARD OF HEALTH ......... 3 SETS OF PLA~;S .......... SURVEY ................... CllEcK ..... CALL . o. o o. HAlL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ets of plans, accur0te 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ,b.~ll 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 ,.ball 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Legulations, 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 buildh~g for necessary-inspections. · ~-. - ' ' (Signature of applicant, - (Mailin,, address of applicant) State whether applicant is owner, l~*~-~w~ _a.mla/, .... e,,~i~eeI-, genAr~! nontr-t!ctor, eLeaztr-bzian, ~"'~"~- ~ ........or b~ ....................................................... . ........................ '<an,e of owner ofpremises ~..~.~.~...~.~'. J>.~.~. ...... .~..~..t~../.~.A~..~.~.j: .................................. (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 ........ Elect c an s Lmense No ...................... Other Trade's License No. /Nc. Location of land on which proposed work will be d, one ......................................... ' ......... llouse Number .................. ~tr;~ ...................... H~m'l;; .................... County Tax Map No. 1000 Section ...... .~.4 ......... Block................../7 Lot . ..,f.~. 'ubdivision ..................................... Filed Map No ............... Lot ............... (Name) ,re existing use and occupancy of premises and intended use and occupancy of proposed construction: dsting use and occupancy ......... .,~'....,e~..~.~. .... ~...bff..~../.~. ................................ ~,nded use and occupancy ..~j~. ,,t-~ ~ · 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem~oval .......... Demolition ..... . ....... i ...... Other Wor ....... 4. Estimated Cost 2', ' sc tion) ............... Fee i (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ..... /. ........ Number o f dwelling units on each floor ....... ./. ....... · If garage, number of cars . . ~ · If bus,ness, commercial or mixe~ occupancy, specify nature and extent of each type of use ........ ~.' ......... , · Dimensions of existing structures, if any: Front ............... Rear .............. Dept ....... Height ............... Nu,gber of Stories ................. h i ....... Dimensions of same structure w alterations or additions: Front Depth .............. i . Height ................. Rear .................. ~. D' ' . ' .....,' . ...................... Number of Stories ................ imenslons of entire new construction: Front ...... Rear . Donth ' ' Height ........... . ....Num her of Stories . ' ................. ~' ................. t~9. Size of lot' Front ' ',~ ......................................... · · .................. liear .... D~_,h .... 10. Date of Purchase ,~,~. ~. /qo~fJ ii '"~.L.' ...... ~ ~._v, ................ v ............ ~* '.'.' i ....... . ....... ' ......... marne o! Former Owner-Y?..'Co.... 1 I. ,~,,~ m u~e msmcr m wmcn prqm~ses are situated ...... ~'~r/b,t .,, 'r'~/ ................ Does proposed construction violhte any zoning law, ordinance or regulation. . ..... 13. Will lot be resraded . ~ ..... ' ................. ,.,___ ~ .... ~, ---,,. · ........ wnl excess fill be removed from premises' Yes o I4. ~mn~ otuwnero~prem~ses~e~ .~w..-~.. -~ ~'~ -- ' -.~ ~ ~ J~9 ................. · muress ..e'.~ ~ ~.- Phe, n~, M~, · --~ hitect., .. . . -- ' ................ ^aaress N ................... Phone No .......... · ,s . . . .............................. ~... Phone No ........ 15. Is th~. p~roperty wJ. th.~,n }00 feet of a tidal wetland? *Yes..'. ' .... Ir yes, Southold ~own Trustees Permit may be required. No ......... ... 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 fiumber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. : TATE OF NEW YORK, ou,,,rry 6Eqt. l< ...... (Name of individual signin mve named. a is the ...... C~N .~fl{.~ 0.~ .... 2.1'r'.l, ............. being duly sworn, deposes and says that he is the applicant contract) (Contractor, agent, corporate officer, etc.) said owner or 'owners and is duly authorized to perform or have performed the said.work and to ~nake and file this plication; 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 selt forth in the application filed therewith· 'om to before me this ~ ................. day of .... ~ ....... , cc ' ub,,c, .. x ... Count ¢ ' (Signature of applicant) FDE: ...... ~Y: -- BIJIL.D~NG DEPARTMENT NOTIFY '/65-1802 9 AM TO 4 PM FOR THE FOLLOWING )NSPECTiONS: 1. FOUNDATION .~ I"WO REQUIRED FO~ POURED CONCRETE 2, ROUGH * FRAMING....8~PI..;UIVI'II~G~.~ ~,. 3. INSUI..ATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRU~ION SHALL THE REQUIREMEN~ OF THE N.Y. STATE CONSTRU~ON & ENERGY CODES. , N~ RESPONSlB~ ' FOR DESIGN OR CON~RU~ION ERRORS