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Home My WebLink About20041-z lvo~r NO. Jl TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 20041 Z Do,e....i~..~... ................................. Permission is hereby granted to: ~.~~....~..~..../...~......~~ .... ................ ...................... ........ ~~~...~..~.~.~.....~..zz~x/ o, ,,emi= ,~a,ed o, ..... ~. ...... ~ ........ ~.?~!~.~r~......~'~ ............................................... County Tox Map No. I000 Section ..... ~..,~. ......... Block ............ ,,~,..,.~,. Lot No ........... ~,,~,. ..... the Building Inspector, Rev. 6/30/80 ..! Examined . Approved ..... 19 ./~'/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 ................... CIlECK .................... SEPTIC FORH .............. Disapproved a/c ..................................... (Bui~i~ ~s~ctor) ' APPLICATION FOR BUI'LDING PERMIT Date ......... ........... 19... 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 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 shall 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the t~x roll or latest deed) If apphcant ~s a corporahon,.S~gnature of duly authorized ofhcer. (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 .................................................... .......................... ......... c,.Id .............. House Numl~er 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' . .... ' .................. b Intended use and occupancy .~ ' (check which applicable)i New Building .......... Addition ..... ..... AlterahqlL'; ......... 3. Nature of work Repair .............-- Remqval .............. Demolition .............. Other Work.. ~.~-It'~C~ ..... k~(~,,~-/~O* '' ' ~ S J~flDescripti°n> 4. Estimated Cost ,,.-~,~w. - Fee (to be paid on filing this application) 5. If dwelling, n mber of dwelhng units ............. Number of dwelling units on each fl6or · If garage, number of cars ..... i .............................................................. 6 If bus' ' 1 or i ~ occupancy pecify natu e and extent of each type ofu . mess, commercla m xe , s r se ..................... 7. Dimensions of existing structures, if any Front ........... Rear .............. Depth .............. Height ............... Number of Stories ........................................................ Dimensions of same structure wilh alterations or additions: Front Rear Depth .................... I.. Height .................... Number of Stories D~menmons of entire new construchon: Front ............... Rear ............... Depth .. ............ Height Number of Stories 9. Sizeoflot: Front ..... · . ~ ~1 ........ .Re~ 10. Date of Purchase .~.~.'~.ertffQ.~. ar ...................... ~D. epth ......... . ........... ,.. , . · .... ....... Name of Former Owner .~'Y[air~O~f~(-:. 11. Zone or use district in which pre~mses are situated ~ ..................................... 12. D.o. es proposed construct~iofi violate any zoning law, ordinance or regulation: ....~O .... 13. Will lot be regraded ~ · . · ' ~'~X:.' ~ ...... .',: ~: · · 't.' .... Will exce~ss fill be.removed from premises: _ ,~Y~s.~_ No 14. ,N, am e of O. wner o f premises ~/~q~l~tt~7-..'[~ ~}~ Addressc~J~O.,... Phone No. ~(~.~.... marne of Architect , y.. i ' I~ Adar~o -- ~h x~ ,-- ......... r ........................................... one,,o. .--: ........... Name of Contractor ..... ~'" i ........... Address '~ . . Phon~e.)5/o. 15. Is this property within 3.00. eet of a tidal wetland? *Yes ........ No.. ~. ..... · If yes, Southold Tiown Trustees Permit may be required. PLOT DIAGRAM Locate dearly and distinctly all huildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptio~L according to deed, and show street names and indicate whether interior or corner Iot. APPB*OVEI:} AS NOTED 7fl~-?~02 9 AM ~ 4 PM gOR THE FOLLOWING iNSPECTIONS: 1. FOUNDATION ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION 8HA~ ME~ THE REQUIREMEN~ OF THE N.~ STATE CONSTRU~ION & ENERGY CODES~, N~ RES~tB~ ~OR DESIGN OR CONSTRU~ION ERRORS STATE OF NEW YORK, COUNTY OF ................. .................. ............ i ................... being duly sworn, deposes and says that he is the applicant (N ..... ig t) amc of mdw~dual slgmn contrac · above named. He is the ....................... i .................................................................. I (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 contaified in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith· Sworn to before me this i o~,P., .day of.. ...... , 19 .~.../ Notary Public ..... ~ ~. County . EtENK~W~. NOTARY P,UBLIO, S~ of ~ l"m'k ............... . No. 4707878, Suffolk ~. ~Sigffature o f applicant) ~m'm ExpI~ March ~0,19-Z.Z.O