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Home My WebLink About19780-z LvOB. M NO. 0 TOWN 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_ 19780 Z Date .......................... , 19.~. Permission is hereby granted to: ~o ......................................................... .~ ...................... ~/'0' ........... ~ ................................. at premises located at ../...~.......~. .......... .~...T.. .......................... County Tax Map No. lO00 Sectio/~...J~./;.~. ......... Block .....~....--/.. ......... Lot No ..... ~...~.. ............ pursuant to application dated ....~......Z...'~... ................. , Ig.c]../..., and approved by the Building Inspector. Fee ).,~.~ ............... Rev. 6/30/80 NO 7Id NO -~ON.~_q $OV~OO~ ',0l ,8~ .90 N FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18(12 Approved . ./..~.., 19~/!. Permit No./.9.7.8.q..~ Disapproved a/c ................................ . ..~) (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... ] SETS OF PLANS .......... SURVEY ................... Cll~CK .................... SEPTIC FORH .............. CALL ................... MAIL TO: 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 of 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'~mmcnced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shail 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 cod_e.t hoosin~Kcode, and regulations, and to admit authorized inspectors on premises and in building for -- (S~~-~ant, or nam e, if a corporation) (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 t~a~' 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 ......................... Electrician's License No ....................... Other Trade's License No ...................... I Location of land on which proposed work will be done... 1.L~-,4'.o.. ............................. . .'..' . ..... 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 occunancv b. Intended use and occupancy ..................... .................... · ~11 ~. ~ . ~..~,,-......, ........ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .~.~.,. / (Descriptioni 4. Estimated Cost ..... ,o ~ F ................................. ee .......... (t b paid fil' g{~h~' · ppli ) 0 e on m isa cation 5. If dwelling, number of dwelling un its ............... Number of dwelling units on each floor ................ · If garage, number of cars ....... , ................................................................. 6. If business, commercial or mixed, ecupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures if any Front Rear Depth Height Num bqr o f S tories Dimensions of same structure with! alterations or additions: Front Rear Depth ...................... i Height ...................... Number of Stories ..................... 8. Dimensions of entire new construchon: Front ............... Rear ............... Depth .............. Height ............... Numb~,r of Stories .................................. 9 Size of lot: Front Rear .............. I ............................ Depth ...................... 10 Date of Purchase ~ ' Name of Former Owner 11. Zone or use district in which premises are situated .......... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........... [ ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..... i ............... Address ................... Phone No ................ Name of Architect ............ ~;. .............. Address ...................PhoneNo ................ Name of Contractor , Address Phone No 15. Is this property within 300 feet of 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 number or ' '" · descnpQon according to deed, and show street names and indicate whether interior or coruer lot. STATE OF NEW YO~o, ,~ S.~ cou ¥ ! ..... ..... · i. APPROVED AS NOTED ' DATE: FEE'--~,~-~', '-'" nv.'~. (~ L, - N~I~Y BUILDING DEPARTMENT AT 765-t802 9 AM TO g PM FOR THE FOLLOWING INSPECTIONS. I, FOUNOATiON '~O REQUIRED FOR POURED CONCRETE 2. ROUGH · FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST ME COMPLETE FO~ C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF TH~ ~TATE CONSTRUCTION & ENERGY ~ODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ................. being duly sworn, deposes and says that he is the applicant (Name of individual ' ' mgmng contract) above named· He is the ,' ,~ (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly duthorized to perform or have performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner s~t forth in the application filed therewith. 5woru to before me this JOYCE M, WILKIN$ Notary Publl~. State of NeW YeI~. .............................................. No. 4952246, Suffolk Coun~ (Signature of applicant) Term Explrea June 12, 1~,,~.J