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Home My WebLink About19406-z FO~M NO. ~ TOWH OF $OUTHOLD BUILDING DEPARTMENT TO~h~'H HAL~ SOUTHOLD, N. ~. BUILDING PER~IT (THIS PEEMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~ION OF THE WORK AUTHORIZED) N~_ ~ 940~ Z Permission is hereby granted to: . ~ /'~ , .... .................... ~~ ~. , u' ~ ........... ._.. ......... : .................. ~. ............. ~ ...... .~ ........ . ot ,r,,,,e, ,o~o,ed at .~.~.~.~......~...~.....~ .................... .~~i .................... County Tax Map No, 1000 Section ........ .q~..,~..'].. ..... Block ...... ...C~.....'~.. ...... Lot No ........~.....:....~%.. ..... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUT14OLD. N.Y. 11971 TEL.: 765.1802 ^ppro, e~ .UI .. lg.~.°. Pe~it No. l .fl .'/..O.. (,..-2: Disapproved aJc ........... ............... iiii (Budding [nspccto~ ) .APPLICATION FOR BUILDING PEI:tg/IlT INSTRUCTIONS SURVEY ................ · .... ................. SEPTIC NOTIFY~ HAIL · a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building I~'pector, with sets of plans, accurate plrJt 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 pan of this appli- cation· ¢. The work covered by this application may not be commenced before issuance of Build' ~, d. Upon approval of this application, the Buildln,, · ......... , ~ mo Permit. - ._,, ~-~pecmr wm Issuca a ~uilding 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 a.ny purpose whatever until a Certificate of Occupancy ~hall have been granted by the Building Inspector. APPLICATION I~ 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 tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as he,in described. Fbe applicant agrees to comply with all applicable laws, ordinances, building code, housina code, and regulations, and to ~dmit author/zed inspectors on premises and in building for necessary inspections. . (S,gnatu~e'o'£~'p'l~l~Cant, or name', ff a .... ' ~ * Pp leant) dtate wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,; (as on the tax roll or latest deed) .. ' ' i' appl cant is a corpora fi'0n,! signati.~re of duly authorized officer. (Name and title of corporate o.0fficer)~ B ddersL,ce se I ' ' ' · Plutnbcr's License No ' Electrician's License No .................... Other Trade's License No Location of [and on which,~proposed work will b,: done: " ......................... ~ · . ........................ / ,~/~ --~ -· llouse Number /'/ ' Street. ' ' ' ........ Hamlet ' ou ap o ec on .... : BI~ k , '" ....... -. C '' .... Lot S bdi iion ......................... :''' u v s ..................................... El:ed Map No. (Name) .............. Lot ............... Slate e.~:isting use and occupancy of premises and intended usc and occupancy O£proposed construction: o_, ....::::::::;:!.::.:. b. lntendeduseandoccupancy ... ' .........i U-, ~., ,,., ,. . ' ature of work (check which applicabli): New Building ......... Additic.,a,~. ......... Altcratioa ........... Yennxs Courg ...... ~.. Accesdory Building .......... Fehce ....... OCher ~ork; ........... E~timated Cost ~ (to be paid on filing this a~p~tion) . If dwelling, number of dwelling units ., ............. Number of dwelling units on each floor ................. If garage number ofcar~ ~ .. If business, commercial orlmixad occu{ ancy, s0ecify natn[e and extent of eac~pe of use ..... Height .... ~ ...... Ii. Number of Stories ... ~ .................................................... Dimensions of same st~ct~ro with alterations or additions: Front ................. Roar .............. D~pth ............... I ....... }Ie~t ..................... '. Number of Stode~ ................... ;. Dimemiom of entire new conxtn~ction~ Front ............... Rear ............... De~th ............. Height ~ Number of ~Stodes ' '. Si~e of lot: Front I ' Rear Depth 1.' Date of Purchase .. J I Name of For;ncr Owner ........ Zone or use d~strict in which premises ~re situated ' ..' Does proposed construction violate any zoning law, ordinance or regulation: ....... , .............. '. · >." W~I lot be receded. .. .~....' . ' ... Will exce~ fill be remo~dd from premises: [ N~,: of Owner of premises i .... ~ .... Addre~ Phone No N~a of Architect ....~l ........ ,. ~ ....... b ..... Addregs ............. ;..'... Phone No ......... S.ls thzs p~operty ]located ~ithin 100 feet of a tidal ~etland? ~gS .... PLOT DIAG~M Locate cla~ly ~d distantly ~1 building, whather existing or proposed, ~d. indicate ~I sat-back d~siona fro~ :opa~y ~nes. Giw atraat ~d]block numb{ r or description accord~g to d~ed, ~d show street n~a and ~t~ whethar ~terior or comer lot. APPROVED AS NOTED " N!~I't~Y' BUILDING DEPARTMENT AT · 765]1802 9 A~ TO 4 PM FOR THE FO~LOWIN~ INSPECTIONS: 2/~OUGH - FRAMING & ~ INSU~TION q. FINAL - CONSTRUCTION MUST / ~ECOMPLETE FOR /ALL CONSTRUCTION SHALL MEET ,/ THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTI~ & ENERGY COOES. N~ RESPONSIB~ FOR DESIGN OR CONSTRU~ION ERRORS oF O NT ' OF. s.s ,- ,~, , ~; ~, ,ua~::l's::'~i:l~'"'":,''':'--''''''~ .......... being duly sworn, deposes and says that he is the applicant (N mc of individ bore named. .. is the ' ' (Contractor, agent, corporate officer, etc.) said owner or owners, an~ is duly autt~orized to peyform or 'have performed tile said work and to make and file this pPl!catton; that all statemenlts contained {tn this appiicatioo are true to tile best of his knowledge and belief; and that the 'otk will bc performed in tile manner set fort I in thc application filed therewith. ' / (Signature of applicant)