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Home My WebLink About19818-z FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) No- 19818 Z Permission is hereby granted to: ..._ ...~..~...~.....~.:.~.,.....1.1.~.~.~. , ,o.~~...~....&'.~:...~..~.~.,a_....~.~.....~......y.~,~ ~... ---~" .......................... '""-'"'"'"'":' ........... ~a'i ...... ;' ............ ; ............ o""~'--a .... Building Inspector. and approved by the Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALI'H ......... 3 SETS OF PLA~;S .......... SURVEY ................... CI1ECK .............. (Building Inspector) 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 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 premises or public streets .r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be c~bmmenced 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. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy .Sail 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 ;uilding 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 code, housing code, and regulations, and to dmit author/zed inspectors on premises and in building for necessary inspections. ~Sig. nature_ o f_ applicant, or name, if a corporar/on) (Mailing address of applicant) Iq'"] ~ 1~, ~'~ grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. las n the tar~ roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... .~..~4q'.. ~ ~ ..7'. ...... Plumber's License No ......................... Electrician's License No ....................... Other rrade's License No ...................... d~ ~--(f2~_~9 /~/ff'/z,/ Location ofland on which proposed work will be done. ~ ~E~ ~.~J~O~N~ .. g hE.. 6 9.,... 9. ,,.. k,.x .. [& Kb. ..... 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 ...~,~'~.· ~ ~ '~.. ~ .0]P. ...... ' ,.4~?e"~' ;'~ ....................... ~'~ b. Intended use and occupancy .... . ~ ...................... . , , N ' 3. ature of work (cheek which applicable): New Building .......... Addition Repmr .... Remoia1 .............. Demolition .............. Other Wo r~.~.'~.~..~/ . ~, .~..~-~} .~. (Description) 4. Estimated Cost .... ' ...................... Fee ...................................... (to be paid on flll~l~ }his app' lcaDon) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................ · If garage, number of cars .... .~.. ...................... 6. If business, commercial or mixed ' ' .... ~ylP ...... h ...... · ........... .occupancy, specify nature and extent of each t e of use [J~.O 7. Dimensions of existing structuresI ir ~-- ~ .... O,;-,d, ,. ,~ · ' : · u~: ,., · ~. ~ ,, ~ · ""Y' ~.~un[...o~..,:~. ...... l~ear . ..'~ J~ ........ Depth . .~-.~. · '~,g-[ · · · .~ ~ ........ ~umher of Stories .... .W.K).k~ ...... ' ..... Dimensions of same structure with alterations or additions. Front ' ~[~-' ~.~ ~i ~.'~'~' ' '~'"'-' ' ':'-; .............. Depth ........ ~ ........ l' .Height ~ · ... Number of Stories ~ 8. Dimensions of entire new construetmn: Front ............... Rear ............... Depth ............... Height ......... Num hl~r cfi 9. Size of lot: Front .. [.O [ .~.~. Rear ' '.~.d~'~'~h, .......... ;.":,' .... t'ii'e~g [~ ............ lO. z oa;Oo rS: g ........................... ........... · ... .... . ...... . ........ ., 11. ictin pr}~i~e's~re situated . .:. . .. .~. i~..~.~: ..... 12. Does proposed construction viol~aie any zoning law, ordinance or regulation' 13. · ill excss_s fi~ be re_moved Ir_om premises: _ Yes 14. r ~ s ~/11 .&~.* ..... Address ,. Phone Name of Architect ........ :.. k '; .............. Address ................... Phone No ................ Name of Contractor ........ . .'r'a~, .~.. · . · Address .... t . Pho~n~,No ................ Is this property within 30:0 fe'e't' ~'f' ~' tidal wetland? '*vo'~'$'l!' ):~I' ' ' No..~ ..... · If yes, Southold To~n Trustees Permzt may be required.[ PLOT DIAGRAM Locate clearly and distinctly all bhildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether interior or comer lot. TATE OF NEW YO~,~ ~. .... (Name of individual signing 5ontract) )ore named. ~PPi~OV[§ AS NOTIFY BUIL£)ING D£PARTMENT 765-1802 9 AM TO 4 PM FOR TNE FOLLOWING INbPEC31ONS, 1. FOtJNDATIO~ TWO REQUIRED FOR P~URED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MU~T BE COMPLETE FOR C,O ALL CONSTRUCTION 8HALL MEET THE REQUIREMENT~ OF THE STATE OON~TRU~TION & ENERGY COBE~. N~ RESPONSIBLE FOR DESIGN OR OONSTRUCTION ERROR8 being duly sworn, deposes and says that he is the applicant e is the .......................... (Contractor agent corporate officer etc ) ............... · s..aid owner or owners and is duly authorized to perform or have performed the said work and to make and file this ,Pncation; 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 seti forth in the application filed therewith. yom to before me this ......... oD. )t ary Public, . .~./~.'~~;?~