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Home My WebLink About19731-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 197~I Z Date .~r ............................................ , Permission is hereby granted to: .v,,x,,=..-~ __ ...~..~..~~.~...~.../..:~.~ ...... ..... ........................ Ot premises Iocoted ot ...... .~../..:~.~........~......~:. ..................................................................... ................................................ ~~:~ ....................................................................... co~ Tox Mop No. ~000 S,c, on ....... :.~/.. .... B~k ....... ../.. ........... Lot No....~..../.. ......... Building Inspector. and approved by the Rev. 6130180 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 MAR 2 01991 m..,,~-,,--,.. ' 'i". TOVYN OF SOtB"HO~ Approved..~ ...... , 19 ~Pemit No. Disapproved a/c ..................................... ~5 F ~~ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORM .............. CALL~';'%. · ~.V~-~,Xc~-M ~ .... MAIL TO: INSTRUCTIONS a. Tiffs 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 commenced 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 occup~/r used in ~hatev~q~l a Certificate of Occupancy shall have been granted by the Buildinglnspector. · APPLICATION IS HEREBY MADE to the Building Depirtment 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, ordinanceq~, b{~ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessar~~ Q~ q~ %~ - -. !Signature of applicant, or name, if a corporation) ... ................... ~. C~ ~aiJ~g add,ss of ~li~a~t) q N~" ~'C State whether applicanf is owner, lessee, agent, architect, engineer, general contractor, electncmn, pl~/mber or builder. .... o. ............................................................................. Name of owner of promises . .. .......... .............................................................. .. ~ , (as on the tax roll or latest deed If applig'dnt;is a:c0fPo~at?n, 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. ~ · p t ~'J ~---. ~:>'~ House Number Street Hamlet County Tax Map No. 1000 Section ... I.c[.I ............ Block ... I .............. Lot..~l ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .t a. Existing use and occupancy... ~..~../~..~..~.~.!..~.<: . .~..~ J..~...~.....~. !. ,.~"~.. .... '.~..S ~ ........... b. Intended use and occupancy ....................................................... Alterati~j)~.~.. Repair .............. Rem~ ,val .............. Demolition ........... --- Other Work.. ~. ~.~. ....... ~. . ,. 1~ ir~T'- (Description) 7oo:o ' ' 4 Estimat dCost Fee " (to be paid on filing this application) 5. If dwelling, number of dwelling mits ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... I ................................................................... 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 ............... Numlber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth i Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Numiber of Stories ........................................................ 9 Size of lot: Front ' Rear Depth 10 Date of Purchase ' Name of Former Owner 11 Z d' ' ' whichpre~ situated . one or use lStrlct m mises are ................................. ·.: ............. ' l~t y oning law ordinance' egulation: .... 12. Does proposed Construction rio e an z , : or r ................................ 13. Will lot beregraded.........i ...................Willexcesstillberemovedfrompremises: Yes No 14. Name of Owner of premises ... i ................. Address ................... Phone No ................ Name of Architect .......... [ ................. Address ................... Phone No ................ Name of Contractor ......... , ................. Address .................. Phone,No ................ 1.5. Is this property within ~00 feet of a tidal wetland? '*Yes ........ No...Y~. ..... · Tf yes, Southold ~own Trustees Parfait may be required. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVgO AS ri) NOTIFY BOiL/gl-NO DEPA~ AT 765-'1802 9 AM TO 4 PM FOR THE' FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRuCTIoN MUST ~}E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STA,,TE OF NF_2~ YORK, "~ S · ,~-~-~'=. · ~...-.,,~ ~ .....-~,.~-'~-,~. ~ .~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· He is the..~).. ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this application; that all statements contai.hed in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Swojt! to before me this - ........ ................. ~ ..... uay Ol..,., ....... Notary Public ..... liE[iff K. OE ~/OE i ' NOTARY PUBLIC, StYe o~ New Yo~ _ N0.~707871t. Suffolk C0ur~