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Home My WebLink About19752-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) N~ 19752 Z Permission is hereby granted to: ~ ' ...... '""'-'"'~' ................. '"1 .................... ::~ .......... ,o ................................ County Tax Map No. 1000 Section ..... C~..!..~..'~.. ....... Block ..... ,,~:~.., ,'~. ........ Lot No......~ ................. pursuant to application doted., ~...~..,.,....'~.. ................... , 19..~.1..., and approved by the Building Inspector. Fee *.~.: .......... Building Inspector Rev. 6/30/80 Examined. Approved~.. BLDG. DEPT. lth~N OF SOUTHOLD .4-. .... ,19 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .... . ................................. /~ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOAR[} OF HEALTH ......... SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: 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"ommenced before issuance of Building Permit. ,cl. 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. i~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shai~l 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, housi~ng code, and /./2' admit authorized inspectors on premises and in building for neces~~ ~gulations, and to (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. ]..~. ~'x.~--A.b,]....~'...~..~,~X.~.C~.~..Q).~..~..~-~., .................... (as on the t,al' roil or latest deed) If applicant is a corporation, signature o f 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 .................................................. ............ ................ ..................... House Number Street Hamlet / County Tax Map No. 1000 Section ..... , ............. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~.~,~.~..~,,..~ .~'_'_~x~.~_..~...,~,..~/~...~?~.~.,.,~[ .~..~. · ' ....... ~*'~' t?, '~it ff~a~,~ ~ ~¢;~ ........ b. Intended use and occupancy .........................~,~'" .~.~r.~,,.~.,~ ~ ~'~. ; ..~.,,. ~:; ~.d.~.%~i ,,..(.~,~ ... .......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ......... ~,... Remo!ai .............. Demolition ............... Other Work. ~...~. L',,J..Q~ 4. Estimated Cost ......... ] (t9 be 0aid on filing this. application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling' units~0~' each floor If garage number of cars i ............ ~' ........ 6. If business, commercial or mixedloccupancy, specify nature and extent of each type o.f use .................... 7. Dimensions of existing structures., if any: Front ............... Rear .............. D. ep..th .' ............. Height ............... NumSer of Stories ..................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ..................... ]. Height ..................... Number of Stories ................ 8. Dimensions of entire new construction.. Front . .*~,. ~, '~[' n,,o, ' ~'~,~, ' Height NumBer of Stories ' 9. Size of lot: Front ............ I .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ l ........ ' ......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... i ................ Address ................... Phone No ................ Name of Architect ........... I ................ Address ................... Phone No ................ Name of Contractor .......... ~ ................ Address ................... Phone No ....... 15. Is this property within 3 0 feet of a tidal wetland? *Yes ........ No. ........ ' ........ *If yes, Southold TOwn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bmldmgs, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~ ~mber or descfiptio~i according to deed, and show street names and indicate whether interior or corner lot. APPROVE:D AS NOTED DATE: ~ B.P',~ h'~:/~FY ~t:~i~O~NG DEPARTMENT AT 765-~802 9 AMjTO 4 PM FOR FOLLOWING INSCECTIONf5. 1, FOUNDATION~ · TWO FOR F OURED ,CONCRETE 2. ROUGH - FRAMING & PLUMBING 3~ INSULATION i 4,, FINAL C~NSTRUCTION MUS% ~E COMP .ET~ FOR C.O ALL CONSTRU(;TIO <SHAkL MEET THE R~QUIREMENTS OF THE N.Y~ STA~E CONSTRUCTION & ENERGY CODES. NOT ~RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEeDle/~ t' COUNTY .... ~.~.~ ~..~T..~ ~.Q.(9.~_~C ... being duly sworn, deposes ~d says that he is the applicant (Name of individual signin~ contract) above named. ' He is the ....................... ~. ~.~ .... (Contractor agent corporate officer etc) 3f said owner or owners, ~d is duly ~uthoHzed to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner s~t forth in the, application filed therewith. ~wom to before me this ............ . ...- Q~l~inB[~k~.~/~ / [ / (Signatu~ofapphcant)