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Home My WebLink About20046-z 1~0~'_ I~IO. II TG~H Of JOUT~OLD 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-o 20046 Z / Date .... .... '~,.~./...~.~'6 ...................................... , 19..?./ Permission is hereby granted to: /a/~ . ~'~~.....~..~ ........ ~...~=,~ ~.....~.~...~~...I.~ ......... ~..,:~,~,~.~,....~..~.'- ,.-., ..... ~..~' . ~ .Z / x' '-Z~"~"~' /' ~ "'~Z~ii~:i ............................. " ....... ~"~"~'~ ..................... " .................................. ~].[.....m..s s located at .....,~...*'Z~.~.....~_~..~~.......~..,/~. ................................ co..~ Tax Mop ,o. ,000 Sec,o. .... ..y~...~ .......... B,~k ....... ~ .... Lot,o ....... ..~...~ ..... pursuant to application dated ..... ~ ..................................... , 19..~./..., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined . ~ Approved...~.~.~ ..... 19 . . . Permit No....~....°...~6~ Disapproved a/c ..................................... BOARD OF HEALTH ......... ~3 SETS OF PLANS .......... --SURVEY ................... ~CI{ECK .................... SEPTIC FORH HAIL TO: . (Bu/~difig I~ect'dr) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 gets 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 ~ode, j}ousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ~?~lZion~ · ............................ -- . (Sigl~atureof applicant, or name, r[f 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~x 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 ...................... 1. Location of land on which proposed work will be done .................................................. { ._,../~ ~ ....... .5~. ~(.~, CL~C~.~..' ~'~ "Street .~fc,~ ,. i~ .~m. ~..~ ~.~. ~ ............. House Number 1 County Tax ~ap No. 1000 Section...:0 ........... Block .~.~.,~ ..... Lot ...... [~.:~ ........ (Name) 2. State existing use and occupancy of pre'es~ ~ ~.~ ~and intende~se and occppancy of proposed construction: a. Existing use and occupancy .... ~.~.~.).~..~ .U.{.~.~...~.*~. ;;~(,~h~;::~__ ._ '~ ................. b. Intended use and occupancy ......... '~.~ .................... ~,,.~,.;:}~,,~;:;~,~:[j~,.,:,~,f~ ............. 3. Nature of work (check which applicable). New Building Addition ..... Alterati~j1.... .......... Repair .............. Removal .............. Demolition .............. Other Work.. t-:l~ ~... 4. Estimated Cost. 'x'''"'"'i .... Fee ................ jg: ........... ~ (to be paid on 1gl~Yhis application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor.. .............. · If garage, number of cars ..... ' ............................................. ; ..................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth Height ............... Numper of Stories ....................................................... - Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth .................... ;. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........~ .......... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ ................. 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 I',)o ................ 15. Is this property within 300 feet of a tidal wetland? *Yes *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 humber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. (1 .a. ............ (Name of individual signihg contract) above named. APpI~OV,[4~ AS NOTED NO'rlY~Ol~G DEPART~T AT 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION '~0 REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST ~ BE COMPLETE FOR C.O, ALL CONSTRU~ION SHA~ ME~ THE REQUIREMENTS OF THE N,Y, STATE CONSTRU~ON & ENERGY CODES. N~ RESPON818~ FOR DESIGN OR CONSTRU~ION ERRORS being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or. owners, and m duly authorized to perform or have performed the said work and to make and file this application; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ' Qu,,,lifled in Suffolk ~ ~ .~ ,.~ _..~. I/ (Signature of applicant) LANE . 123.91'