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Home My WebLink About19843-zTOWN OF $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 19843 Z Permission is h_erebg granted to~ ~ ~ at premises I '-- ' ~ ocotea tit ............................................................... ~., ..................................................... County Tax Map No. 1000 Section ...... ~ .... Block ......... ./.,, ........ Lot No ........... ~,, ........ pursuant to oppllcotion doted ........ ~ ............................... 19..~/..., and approved by the Ouilding Inspector. Fee $ .............. Rev. 6/30/80 "o '¢ .OS ..... ~ 0 ]xaminc, \pproved. ~..~./ ..~/... FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 )isapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... ............... SEPTIC .............. ' INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 ' are~}s, and giving a detailed description of layout of property must be drawn on the diagram which is pan: of this appli- Ltion. C. The work covered by tiffs application may not be c'Dmmenced before issuance of Building Permit. d., Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit all 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 all 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 ~ilding Zone Ordinance of the Town of Sou:hold, Suffolk County, New York, and other applicable Laws, Ordinances or :gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .tz ................................................ ... ....................... .......... ,me ofowner ofpremises : .... . .~.~. ~ d(--t-~c ~Ta>,~'.E' .Z:..~'. (as on the trrl roll or latest deed) .... applicant is a corporation, signature of duly authorized officer. ,' (Name and title of corporate :officer)' Bu , er's License No .... ....... '... Plum ber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Lo ti ofl d hit d kwillb d ca on an on w c~propose wot e one ................ 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:" L Existino us~ o ~,,,,u occupancy . ). Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition Alteration ........... Repair .............. Removal .............. Demolition ........ Other . , ~ ~ · ascript on) 4. Estimated Cost ~ ..~o"~ ~ 't , ............. ~ ............... Fee . .. If garage number of cars ............... units on each floor 6. If business, commercial or mix~-'l--CUpancy specify nature and extent of each type of use 7 Dimensionsofexistingstructurea: if any: Front Height ................ Rear Depth N mSer of Stories '"'"'"'"''' .......... Dimensions of same structure ........................................................ with alterations or additions: Front ................. Rear ................. Depth ., "" . ' ............ i ne~gnr Number of Stories 8 ~tmenslons of entire new constru ...................... · 'trion: Front Rear Height Num bier of Storie, s ......................... Depth ............ 9 Size of lot: Front ' ............................................... I0' Date of Purchase ...................... Rear ...................... Depth ...................... · i Name of Former Owner 1 I. Zone or use district in which premises are situated .......................... 12. Does proposed construct oa,vio a e any zonin aw, ordinance or regulation: ............................... 13. Will ot be regraded ..... ' ' '."' '3c' 'i ........... '~ ...... Wall excess fill be removed from premises: Yes No 14. rqameolUwnero~prem~sesk...~.~.~.~-..~.,F.~...~..~).. Address . · PhoneNo ,7.3~ ...... Name - of Architect ....... i ......... Address ............ , ....... Phone No ................ Name of Contractor ........ i ............... Address ...0.. '~ ............. Pho ........ L5. Is this property within '3~'0 feet of a tidal wetland, n~/No ........ , Yes ........ No. ~' ...... ~If yes, Southold Town Trustees Permit may be required. PLOT DIAG RAM Locate clearly and distinctly all b¢ildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block nulmber or descriptioh according to deed, and show street names and indicate whether, interior or coruer lot. ?ATE OF NEW YOR~ v.e, .t. 3UNTY OF '~' o ~ ,~'D~(_ ....... .... (Narhe of individual signing c ore named. )ntract) FEE: . aY- ~tm-~802 9 A~ ~ 7 T,.~ ~u '~' ~u 4 PM F FOLLOW;NG INSPecTIONs: OR TH~ ~. FOUNDATION . '~0 ~EQUIR FOR POURED CONCREYE ED 2. ROUGH., FRAMING & PLUMfING 3. ~NSU~TION 4, F~AL . CONSTRUCTION MUST BE COMPLETE FOR~ C,O, ALL ~ONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N,~ STA~ CONSTRU~oN & ENERGY CODEs. N~ RESPONslB~ FOR DESIGN OR CONSTRUe/oN ERRORS being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) said OWner or owners, and is duly authorized to perform or have performed the said work and to m,'tke and file this ri}Cation; that all statemeuts contained lin this application are true to the best of his knowledge and belief; and that the will be performed in the manner set ~orth in the application filed therewith. om to before me this /~ i .......... .... ..... '0;'" '' 7~"~_'~:._M~~. County . // . ......