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Home My WebLink About19982-z ~0~ NO. 0 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERAAIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9982 Z Permission Is hereby granted to: ~ . /~ .... ~~ ........... ..~..~....~.~..~..v..~ ...... ,o ..... ..... m~ ............. '~ ................................. : ...... :- ...... ~I../..~. .......... ~ .............. .~ ........ ~... at premises located at ..... ..~..~..~........(~~...~ ........ ~ o" .... .~.1 ............ County Tax Mop No. 1000 Section ...... .(~.~...~ ...... Block ......... ~ ......... Lot No. pursuant to application dated ......... ...~.,.~.......~...,~), .......... , Ig...~.l., and approved by the ! Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ]~..~..o~..~., 19 .~.}. Approved . .~ (~., 19 .q.]. Permit No. }..¢~ .~ .~..~..~. Disapproved a/c ........................ . ....... ......//"~ ................. ' ............... APPLICATION FOR BUILDING PERMIT BOARD OF }tEAl. TH ......... 3 SETS OF PLANS .......... SURVEY ................... C. IIECI< .................... SEPTIC FORH CALL HAIL TO: Date ................... , 19... 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 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 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, building code,-housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~ /2~_ ff~ --- (Signature of applicant, or name, if a corporation) · 4e. 5 z. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~ (as on the taxx roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of co~orate officer) Builder's License No. O/"~?t/&~?4} Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.----~'~ O ~/i' ~c~/I/p/e~'/~g)~ ~/4Z/~. ............................................................. ................... House Numl~er Street Hamlet County Tax Map No. ]000 Section .................. Block .................. lot ................... Subdivision ..................................... Fi]ed Map No ............... Lot ..... .......... (Na~ne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing occupancy ....~. .................................................. a. Use and b I d d d ~/4/Ve. · nten e use an occupancy .................................. ~..,;...,,i ... ........................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~,.n Repair ............. - Removhl .............. Demolition .............. Other Work,/7.e/~. a~. ~. .... · (Description) 4. Estimated Cos~/~...~.O. ....... ....................... Fee...~..~.. ............................... (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................. · If garage, number of cars ...... i ..................................... ............................. 6. If business, commercial or mixed bccupancy, specify nature and extent of each type of use ..................... 7 Dimensions of existing structures i if any: Front ' Rear ..... Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... '. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construgtion: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ................ ....; ..................................... 9. Size of lot: Front ............ ! .......... Re'ar ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: ..... ~ ........................... 1 3. 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 ................ Nmne of Contractor .......... ! ................ Address ................... Phone No ................ 15. Is this property within 300 feet o£ 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 proposed, and. indicate all set-back dimensions from property lines. Give street and block nCmber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW COUNTY OF .... .......... .... ............. (Name of individual signin'g contract) above named· APPROVED AS NOTED 2. ~OUGH FRAMING & PLUMBING 3. INSULATION 4. FINAl. CONSTRUCTION MUST BE COM~,ETE FOR C,O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENT8 OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant He is the .................. .~. $-.~. ,.~..~'¢7.. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contaified in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. S.wom to before me this .......... .~,/f...day,,~'.../'/ ..... .q...N~,. ,19.. Notary Public ..... // ~1~0~ ~,1''0("81?''~''lt''J'~' ' ............. i~i'g;;;t~r'e' ;; ;pplicant)