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Home My WebLink About19850-zTOWN OF SOUTHOLD 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- 19850 Z Permission is hereby granted to;, ~. ....... at premises ,~ated at ...~..~..~Z .......... ~~.y....~...~ .......................... County Tax Map No. 1000 Section ........ ~...~. ....... Block ....... ~ ....... Lot No ....... pursuant to application doted ........... ..~.~.. ................................ , 19...~l, and approved by the Building Inspector. Fee $..'~Q Inspector Kev. 6/30/80 ;I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....... ~.. , 197f. Disapproved a/c ..................................... ................. . ............... ~PklCATIO~ FO~ BHIkDI~G PERMIT INSTRUCTIONS BOARD OF REALIH ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORH .............. Date..(./~ ............. 19 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 cgmmenced 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 pumuant 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ / / / ....... (.~'! ~..t. ,.':Z..L !~. ~. ~./.~-:~.: f~ ....... -- (Signature of applicant, or name, if a corporation) (Mailing addres~s 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 Licens6 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. · f..4 ............................................ House Number Street Hamlet County Tax Map No. 1000 Section ~)~ & Block g9 '~'"~ Lot ~.. / ! 0'~--' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~.. State existinguse and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / ~'~ ~ ?/~ ~/~ , i ',, , ';" ' ' .. b Intended use and occupancy ' 3. Nature ofw, o~k (cheek which appJicable): New Building .......... Addition .......... Alterati~n .......... Repair ............ RemoVal .............. Demolition .... Other Work ~.~, .ff(,C.~,.~.· , ., , ~(Desg~ption) 4 Estimated Cost ' ' ' ........ I Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................ If garage number oleos 6 Ifb ' ' 1 ' d~ fly f of . us~ness, commerma or m~xe ccupancy, spec nature and extent o each type use ..................... 7. Dimensions of existing st~ctures~ if any: Front Rear Depth Height Number of Sto~es ............................................ D~ensions of same st~cture with alterations or additions: Front ................. Rear .................. Depth ~ HeiSt Number of Sto~es 8. Dimensions of entire new eonst~tion: Front Rear .............................. Depth ............... Height ............... Numb~er of Sto~es ........................................................ 9. Sizeoflot: Front ............ ~... ~ ...... Rear ...................... Depth ...................... 10. Date of Purchase. . ... .... j.. ................ Name of Foyer Owner ............................. 11. Zone or use d~stnct m whmh premises are situated ..................................................... 12. Does proposed construction viola~e any zoning law, ordinance or regulation:. ................................ 13. Will lot be regraded .......... ] .................. Will excess fill be removed from premises: Yes No 14. N~e of Owner of premises .... ~ ............... Address ........... Phone No ........ N~e of Architect ........... ,' ............. ~.. Address ................... Phone No ................ N~e of Contractor .......... ~ ................Address ................... Phone No ................ ~5. ~s chis proparCy ~h~n 3~0 ~eeC of a ~da~ wet,and? ~Yes ........ ~o ......... e~ y~s, SouCho~d To~n Trustees Perm~ may be required. PLOT DIAG~ Locate c/early and distinctly ~1 ~uild~es, whether exis*; prope~y ~nes. G~ve street ~d block number or description aceord~g to deed, and show street n~es and indicate whether inte~or or comer lot. / 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: ~, FOUNDATION _- ~0 REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3, ~NSULATION 4. FINAL -, CONSTRUCTION MUST BE coMPlETE FOR C,O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N.~ STATE CONSTRUC~ON & ENERGY CODES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YO.g..K,N~ COUNTY OF ...... .T'.~b,..~.\.'~.. s'S .... '' '(~a~; ;~i~]~21's~i~k~'c;~)ic~ .......... being duly sworn, deposes and says that he is the applicant tbove named. ~e is the .............................................................................. I (Cont actor agent corporate officer ) ' ' , , , , etc. }f said owner or owners, ~d is duly a~thorized to perform or have perfo~ed the said work and to m~e ~d file this ~pplication; that ail statements containOd ~ this application are true to the best of his knowledge and belief; and that the york will be perfo~ed in the m~ner s~t forth ~ the application filed therewith. ;worn to before me this ........ ....... .... . . . , . ¢. . .. ..................