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Home My WebLink About19739-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) Ne- 19759Z Permission is hereby granted to: ...... .....~..~..~.1..~.~ ...................................................... ..~...~.....~....~.:.~.:.....c~.~.~.~. ............................................. atpremises located at . .~...~..?.....i~. ........ ..~ .... ~ .... ~ : ........ ...~.....o~......~.. ............................. ~. County Tax Map No. 1000 Section .... ..C~...~..I ......... Block ....... ..~.....~:.. ...... Lot No .......~.....~ ............. pursuant to application dated .... '.~....~....~-- ....... ~..~.. ........... , 19..~..(.., and approved by the / Building Inspector. Rev. 6/30/80 M'...., 19n..'. ,\pproved..~...~-~..~t..~.., 19~]. Permit Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ...... · ............. CUECK ....... t?2 ........ SEPTIC FORM ................ NOTIFY CALL .... blAIL TO: INSTRUCTIO NS 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 th. is appli- cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tLiis application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection througJqout 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 Bu/lding 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 a~rees~ to comply with all applicable laws. ordinances, buildin- cod~-housin~ code, :md regulations, and to admit anthorized inspectors on premises and in building for necessaT~t~~~ · ' (Signs' '~' ' 't[{e'o't 'a~l~lic~t'. ~; fi:~ff~'e', if'd&' {,drSt;dd)" ' , · . ' " (Mailin= address of applicant) I 1¢/~? State whether appLic.hnt Js o~vner, less~,'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of o'.vner of premises..~, t2.4~.~[,....~..'.~....~...~...~...'....~.~ ~ ~ ................. (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 ......................... Emct. r Clall S License .NO ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............ ' ...................... ................ ......... }louse Number Street Hamlet CounwraxMapNo. lOOOSection ~100 Block .~.'00 ~V O0 ............................. Lot .............. Subdivision ..................................... F~tCd Map No ............... Lot ............... (Name) 2. State existing nsc and occupancy of premises and intended use and occnpancy of proposed construction: 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... )dterati~:~,T.~/ :...; ..... Rep.n/r .............. Removal .......... Demolition .............. Other Work. 4. Estimated Cost ~ [~0 Fee ........................... (to bc paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ .......... Number of dwelling ?its on eac~ flg?~....: .......... lrgaraec._ numberofcars ...................................................................... 6. If business, commercial or mixed occupancy, specil~gjt~ an~ extent of e~c~ I~ of use .: ....... ~ ........... 7. Dimensions of existing structures, if any: Front...~..-..-..'. Rear . ~: ~ ....... Depth ..~. ,[ ......... Heieht Number of Stones ~ ............................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... tlei~t ......................~ Number of Stohcs ...................... . . . 8. Dlmens:ons ofent:re new construct on ~t .. ~.~... ar ............... D~pth ............... -...~ ..~ Hmght ...... ~ .~ ..... Number of Stones .................................... ~- .-, ................ 9. Size oflot: Front ......... ~] ........ '. ~har".....~]~J]..' .......... Depth .~¢.~= ..... ...~ ....... t0. Date oreurchase ...~[~fi~.~. ................Name of Fomer Owner .~..I<~ ..... :. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violat~ 3ny zoning law, ordinance or regulation: .~D. ....................... W~I lot be regraded .......... ~ ~ ............... Will excess fill be removed from premises: Yes 13. N~e of Owner of premises~4.~ ~.~Addrcss ~&~K. ~.~[ ....... Phone ~o. 14. Nme of Architect ........................... Address ..... [~. ~.~... Phone No ................ N~e of Contractor .......................... Address ................... Phone No ..... ~.. ' .. 15.Is this property located ~ithin$OO feet of a tidal ~ettand? ~YgS...~..- ail yes. Southold Town Irustees Permit may be required. PLOT D1AG~M Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. APPROVED AS NOTED DATE: "~,/'~"?~]B.P ~.J~7-~.~, '~ - FEE: 'P~ '"~ FOLLOWING 'NS"ECT~ONS. 1. ~OUNDATION FOR POURED CONCRETE 3. {NSU~TION 4. FINAL CONSTRUCTION MUST 6E COMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR OESIGN OR CONSTRUCTIOf~ ERRORS STATE OF NEW YORKrY' ~. S.S COVET',' ........ ........ being duly (Name of indMdual signing contract) above named. sworn, deposes and says that he is the applicant ffeisthe ........... 1~..~...,~-... .................................................................. (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 contained in this application are true to thc best of his knowledge and belief; and that the work will he performed in tile manner set forth in the application filud therewith. ,';worn to before me this ............. ...... day or ..... ..... , ,~otary Public m 4'lo'n~?~, ~,,,, ,'"Z""JL-o T~nn'txpires mrcn a~, ,.~ (Signaturc of applicant)