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Home My WebLink About19479-zTOWN OF SOU'F~OLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD~ N. Y. BUILDING FERMIT (THIS.PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- 1947(' ,~ Z ,o .......... ...... ...~~ ........ ~: ........ :~--~.~~~: ......................... ,, premises located at ........... .~.JL~)......~~~ ............................ County Tax Mop No. 1000 Section ...... ././....~....t ..... Block .......... ~. ........ Lot No ....... . ..~.... ......... pursuant to application dated ...... ~...~.....~..~ ........................ , 19..~.~, and approved by the Building Inspector. Fee $. ~~ Rev. 6/30/80 ~l D ~ DbP¥, E an,incd. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHCILD~ N.¥_ 'L%9.71. TEL.: 765.1802 Disapproved a/c . BOARD 3 SETS SURVEY CHECK SEPTIC OF HEALTH ........... ~.~ ~ ...... N~zPY, CALL ............... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink find submitted to the Building sets of plnn% a.ccUrat~ plot plan to scale. Fee =eeording to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is pan of tkis apph- cation. o. The work covered by this application may not be commenced before issuance of Building Permit. 'd. Upon approval of this application, the Building Inspector will issued a Building Permit to the appl/cant. 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 ~;emoval or demolition, as herein described. The applicant agrees to comply with all applicab"le laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in build}n- for necessary inspeqtions.. ' ,. - (S~gnature at apphcant, or name, if a corpora:~c~n') ' · I :' (Ma}hag address o State wh~ther app. lican~,is ~owneL lessee} agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pr'em}scs ~ ~. ..~.. 1 ~ "" · (as on the tax roll or latest deed) ' If applicant is a corl~.o rich* ~ignature oP duly authorized officer. (~ame and~,btD,of corporate officer), Builders License No. ~ ........ Plum ber's License No ......................... Electrician's License No ....................... Olher Trade's License No ................ ~ ..... I. Location of land on which proposed work ~vill be done: }louse Number ' Street, Hmnlet ...... .... e a O. ~ '(Name) ........ Lot ............. State existing use and occupancy of premises and il]tended use and occupancy of proposed construction: B. Intended use and occupancy ....... . .......... 3 N f k (check rich aplplicable): N B ildi g Addition Alteration Tennis Court .... [i,.. ~ccessory Buildzng ......... '.'~',~e .~. ..... Other Work;. ~'. ........ 4. Estimated Cost -~ ./~ ~. ~ 5r~Z~-~t ~ (tS he paid oh filing this application) $. If dwelling, number of dwelling lunits ...~.1~/'~ ......... Number of dwelling units on each floor ......... 6. If. business. Commercial or mixe~ occupancy, specify nature and extent of each type of use ............. 7. Dm~ensions of exist ng structurqs, if any: Front.., ........... Rear . .: ............ Depth ....... Dimensions of same structure wI th alterations or additions: Front ................. Rear ........... ..Height ............ ......... . Number of Stories .................... 'uction: Front ............... Rear ............... Depth ............... tber of Stories ' ' 9 Rear . Depth 10 ................... Name of Former Owner .......................... 1 I. ~'mises are situated ................................................ 12 [ate any zoning law ordinance or regulation: .. . · 13 ..... .~ ...... 2&. ...... Will excess fill be removed from preraiaea: . Name of Architect ......... ~ .................. Address ................... Phone No ................ Name of Contractor .... ... ' Address Phone No [.~.l.a chis property located within''t00 feet of a tidal wetland? *YES .... NO .... · If yes, Southold Towh Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate all set-back dimensionc property lines. Give street and blocl number or description according to deed, and show streei names and indicate interior or corner lot. Depth ................... Dimensions of entire new const Height ............... .blur Size of lot: F~ont .......... Date of Purchase .......... Zone or use district in which pr Does proposed construction vic Wi.Il lot be regraded ..... ~.~ STATE OF NE~V YORK, S.S COUNTY OF.... ............. . (Name of individual si ~ning contract) above named. APPROIII AS NOTED _ 765-1802 9 AM ~ 4 PM ~0. FOLLOmNG NS" C*IONS: FOUNDAnOH - ORmum D FOR POURe CONCRETt 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE STATE CONSTRU~ON & ENERGY CODES. N~ RES~NSIB~ FOR DESIGN OR CONSTRU~ION ERRORS being duly sxvorn, deposes and says that he is the applican lie is the '. .... ' ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file fin application: that alt statements contained in this applic'ation are true to the best of his knowledge and belief; and that tit Work will be performed in the man,er set forth in the application Qled therewith. Sworn to before me this ............ d~ ....... day of.. C.e~.. 19 ~.~. Notary Public ............ County , HELEN K fie VOE NOTARY PUBLIC, S~e of f4ew Yod~ No, 4707878, Suffolk Ceunty,,~, Term Expires ~arc! (Signature of applican~