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Home My WebLink About19779-zTOWN OF SO~THOLD 0UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 19779 Z Date ....... ~-(~.. ............................ , Permission is hereby granted to: ; ~ ~ . /~ ~ ~-~ ~_/~~ ...... .... ~'~"7" ':~'~'"'~ ........ · i~.'"'~~.""'"'iiiiii~....~.....~..~.--~.'~i~iiiii ' ~ ........ ~.....~~~ o ................................ at pmmi~ I~t~ ~t ...~.~.~. ............ ~ ................. pursuant to application dated ....... ~ ........ Z...~, ........... , 19..~..J.., 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.: 765-1803 Examined .., 19~./. Approved '(~' i ii ;.., 19 .~.[. Permit No./. 9..'~.7. ?..~ Disapproved ale ....... ~~ (Bufl&n~, Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTlt 3 SETS OF PLA~$ .......... SURVEY ................... CllECK,. ................... SEPTIG FORH .............. CALL ................... HAIL TO: 19.5t a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 pre~nises or publ/c streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is p~trt 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 ;hall be kept on the premises available for inspection throughout the work. e. Nb building shall be occupied or used in v/hole or in part for any purpose whatever until a Certificate of Occupancy ;hall have been granted by the Building Inspector., APPLICATION IS HEREBY MADE to he Building. Department for the issuance of a Building Permit pursuant to the 3uilding 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. ['he applicant agrees to comply with all applicable laws, ordinances, building cod?, ho..u, sing code, and regulations, and to tdmit authorized inspectors on premises and in building for necessary ...30os. ..... (Mailing address of applicant) 3tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ...... ......... . . ' ~ame of owner of premises ....... (as on the t,,~'¥oll or latest deed) 'f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~...~...' .............. Humber'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 .. [ .~.g.,. C~C) .... Block .C~ 5.,.C)(~ ...... Lot. ~ {.~,.(2tO ...... Subdivision ..................................... ~, ~ Filed Map No ............... Lot ............... · State existing use and occupancy of premises and intended use and occupancy of proposed construction: , · E isti nd a. x ng use a occupancy .................................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removhl .............. Demolition .............. Other Work.. ~. ~[{~.~ (Description;'' 4. Estimated Cost ...... . ...................... Fee ...................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling uffits .............. Number of dwelling units on each floor ..... If garage, number of cars i ' ' .......... 6. If'--' .. . i ............................................................ uusJness, commerc~aJ or m~xed ocCUpancy, specify nature and extent of each type of use ..................... 7 Dimensions ' ' ' if any: Front R. ear Depth · ot existing structures Height Number of Stories ............................................ Dimensions of same structure with[alterations or additions: Front Rear Depth i Height ................................... 8 ............................................ Number of Stories ...................... · Dimensions of entire new construction: Front ............... Rear ..... ' .......... Depth ............... Height ............. .~. Numbe~ of Stories ........... 9. Size ofiot: Front .... ........ Rear q '.M ............ I0. Date of Purchase 'zlf~tl ~q ' ' ';.~' ' ' "'~k' ..... A ..... ......... ~'1"-' t'~''''' ........ ~nameolvormeruwner .(~.~ ..~.,.~p~_&\ .~hC.~ . ~.~ II. Zone or use district in which premises are situated .............................. ..~.i ........ .~ .... .~. 12. oes proposed construction v~olate any zoning law, ordinance or regulation: ................................ 13. Will lot be regrad~ed . .~ .~.(2) - ! . mill excess fil ...... '. .,',',x' '.~, ........ .^. · ~.~_~ 1 oe removea ~rom premises: Yes '~o 14. Name of Owner of premJses ~l~:~~.lFIt0qt. l~II~ss .~. ~t~ .~\[ [,~. Phone No. e~Q~S.-~QO.({~....-~ Name of Architect ' Address Phone No Name of Contractor ........... ; .............. Address ................... Phone No ................ 15. Is this property within 300i feet of a tidal wetland? *Yes ........ .No.~.. .... · If yes, Southold Tow~ Trustees Permit may be required. PLOT DIAGRAM Locate clearly ~nd distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nun tber or descriptio~i according to deed, and show street names and indicate whether interior or coruer lot. ,A~P,~V[[D ASNOTED q. FEE: ~"V: ~' . N~I~ BUILDING DEPARTMENT AT 76~4802 8 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ' ~0 REOUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING ~ PLUMBING 3~ INSULATION ~, FINAL CONSTR~CTION MUS~ 8E COMPLETE FOR C.O ALL CONSTRUCTION SHALL ME~T T~ REqUIReMeNTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CO~ES, N~ RESPONSIRLE FOR OESiGN OR CONSTRUCTION ERRORS ;TATE OF NEW YOR.,K, r~r~ .... ............ [..--~a .~O.~O,.....~d~..~ ~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing cofitract) bore named. '.e is the ~ ~(~ontractor, agenb corporate.officer, etc.) ~ said owner or owners, ~d is dulj "' m~e ~d file this authorized to perfom or have perfomed the said work and to pbcatmn; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ork will be perfomed irt-the m~ner set fo[th in' the application filed therewith.. '. , ~om to before me this ' .~y .......... ...... Ota~ Pubhc,... ~~ ..... ~~unty /I