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Home My WebLink About20238-zTOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20238 Z Date Permission is hereby granted to~ .~ , .......... at promises located at ....~..~...-~...Z..~.....'~....~...~...~...'T ....................................................... County Tax Map No. I000 Section ..... ../....~.r~..... Block .......... ...~........ Lot No.....~..~ ...... pursuant to application dated .../.. ...~.. ................................. , 19.~.~..., and approved by the Building Inspector. Fao $.....~..,,~,~,, Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOAKD OF HEAL/It 3 SETS OF PLANS --SURVEY Cl~UC~ ~b~.; ................ SEPTIC FORM ~:LL~CL,L,:-!:L ,, SOUTHOLD N.Y. 11971 I ........ ~[~!'?i,~(~!? ~?OU ~?!{:~[~. ........ ~ TEL: 765-1802 ~: OT I FY: Examined I.~/.~( ........, 19 7[. ~ ~0' ' ' " ' . ' ' ... Z/o/ ..... ............. ....... ~ ........ ~v ~. rerm~r ~o..~. ~... ~.~ ~ ~. /~ ~, ~ ~lsapproved a/c .... . ................................. ~ ' , ................ ,.,. · g hi APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ?ts 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 )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 Jmlt 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 Certiilcate 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 luilding 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 tdmit authorized inspectors on premises and in building for necessary inspefffi~. ~,~ ~,.~ ' ,. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......:.< . ×amc ofownerofpremises .i~70...~. ~.'7~....~-7../?../~i .~.---?....~...~./..~..~./.~ .......... (as on the tqx roll or latest deed) It' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~. f~..,/..P/.~--...~ ..... Plumber's License No ........ .'. ................ Elcctrc an s L~cense No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................... ' . . . .?.¢-.V. . . . . . .2). . . .... . . . .e. . . . :o-7. . ?. . ...................... llouse Number Street Hamlet Couuty Tax Map No. 1000 Section . /d) ~--~ Block Z/L/ ' ~ ~'~'-"' ................................... Lot ...... ~ ........ .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existiug use and occupancy ~ '-' b. Intended use and occupancy ....... ~/'/-/~ '~' ... ,.,,~. - ~ ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........... Other Work Estimated Cost ........ :~. ..~-d,.".//~. i (D~scription) , , (to be paid on filing this application) 5. If dwelling, number of dwelling Vnits .............. Number of dwellin nits on each floor ..... · If garage, number of cars ..... i .... g ¢ .... If business, commercial or mixe~ occupancy, specify nature and extent of eec e of use ................ 7. Dimensions of existing structureS, if any' Front h typ .... Height . ,., ? .~' ............... Rear ... pth ............ ~'¢umoer el ~tories ..... ' .......... De .............. Dimensions of same structure w alterations or additions: Front ................. Rear ...... Depth .......... , Height .... Number of Stories ............ 8. Dimensions of entire new constnlction: Front ......... ' 'l{;jr ....... · ' ................... Depth .............. e~ght ............... Num er of Stories .................... 9. ~ize of lot: Front ..................... Rear.. ~; .................. Depth .. ............... 10. Date of Purch . rqame of Former Owner ....................... 1 I. or use strict m winch pre lses are situated.. ~ ............. ·. · 12. ~,uca proposed construction violalte any zoning law, ordinance or regulation: ~i i i ...................... 13. Will lot be regraded .......... ..t/. ............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... : ............... Address ................... Phone No ..... Name of Architect , ...... ....................... Address ..... Name of Contractor ..... i ..... · ............. ' .....Phone No ................ ...................... Address ................... Phone No ......... . ....... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No .... · If yes, Southold T~wn Trustees Permit may be required. ' .... .... PLOT DIAGRAM Locate clearly and distinctly all ~uildings, whether existing or proposed, and. indicate all set-back dimensions from~ property lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether interior or comer lot. APPROVED AS NOTED NOTIFY BUlL,DING DEPARTMIEf~T AT 7~5-1802 9 AM TO 4 PM FOR THE FOLLOWING ~NSPECTIONS: I. FOUNDATION ~. TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULAr'ION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET TlqE REOUIREMENTS OF THE N,~. STATE CONSTRUCTION & ENERGY NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NEW '~Fs-t~ , o u,,crv of... .... s:si (Name of individual signing 6ontract) ~ove named. being duly sworn, deposes and says that he is the applicant is the ......................... ,......,~.. m (Contractor agent corporate officer etc ) ......................... said owner or owners, and is duly au:tborized to perform or have performed the said work ,~nd 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 ~rk will be perfo~ed in the m~ner set }forth in the application filed therewith. 'om 1o before me this ~ m ............ .... ' ~ ROBOT I. S ' ~Y PUBLI~, ~(~y. // ........... ~ ~ .~ ~ ......... ~ Z~89,.~ffoik~un~. ~ (8i~natu~e o~appiicant)