The URL can be used to link to this page

Home My WebLink About19325-z IroB~M NO. ~ TOWN OF SOUTI'IOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to.'. ~.~..~ ....... ~,~.~ ................ .................................. ............................................. County Tax Mop No. 1000 Section ..... /..C~...~,. ....... Block ...... ~...C[ ........ Lot No....fl.:....~. ......... pursuant to application dated .L....~.~L~.~.. ........ J;.~.. ......... , 19.~..~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Ap p rove~/~, ~.' 'j'/o'' 19 ~7'~' 199.0. Permit No..~ ?. ~ h'..~' Disapproved a/c .................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: INSTRUCTIONS 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 commenced 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 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 femoral or demolition, as herein described. The applicant agrees to comply with all appli6able laws, ordinances, building code,, hou~3g code, and reg~ations, and to admit authorized inspectors on premises and in building for necessary inspection · ' (Sigr[ature et applicant, or ng~fie, if a ct~porarLon) . . . .. ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architeqt, engineer, general contractor, electrician, plumber or builder. ..... .0..~.. &,..c..-~,/.~.. ......... . ...... '"-' .. ':': .' .......... :" '~ ............................ Name of owner of premises . ; .... ; .......... .. · . .' ..................................... ............ · ,' (as on the tax roll or latest deed) If applicant is a corporation, 5jg~tCr?-o£.dl~lB~uthotSzed,Officer. (Name and title of corporate officer) Builder's License 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 .............. ' ................................ House Number Street Hamlet County Tax Map No.1000 Section ..... .//,2. 2.'..~. ?.. Block...~..~.~. ~ ~ ....... Lot... ~t..~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended, use and occupancy of proposed construction: a Exist n ' ~.~.~, ~'/~;t./~/ ~ ~ D ~C~~ · g use ana occupancy .......... ' ..................... ~ ..... ~"~':~"r' :~ .................. occ.nc ... :... ................ N k ( ' ppi' ) ' 3. ature of wot check winch a lcable: New Building .......... Addition ........... Alteration .......... Re r .............. Removal .............. Demolition ......... .... Other Work.· 4 Estimate'd Cost ~ ~ ~ (Description) · · ................................ Fee ......... ............................. (to b~ paid on filing this application) 5 Ifdwelli be fd iii g it N b fd 11' n.' ach fl · ng, num r o we n un s ............... um er o we lng U ItS on e oor ................ If garage number of cars 6. If business, cominercial or mixed occupancy, specify nature and extent of each t~pe of use .................... 7 Dimensions of existing structures if any: Front Rear ' Depth Height Number of Stories Dhnensions of same structure with alterations or additions: Front ........... ~ ...... Rear ........... Depth Height Number oJf Stories ..... Dimensions of entire new construction: Front Rear ' Depth Height Number of Stories Size of lot: Front ...................... Rear ...................... i Depth .................... 10. Date of Purchase... ~7.~. ~'~ .o~. .... · ·. .. . .. Name of Former Owner } ..................... ... . . 11 Zone or use district in which premises are situated ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ../?'o. ........................... 13. Will lot be regraded .... ~ ?. ................... Will excess fill be removed from premises: Yes Name of Architect .................. Addre~ i Phrm~ lq,-, marne et Contractor ...... .~d'.. 4'~ ............ Address ....... i .....Phone No ....... 15.Is thxs property located wlthxn 300 feet of a tldal wetland? *YES.~.NO.~. · If yes, Southold Town Trustees Permit may be require~. .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& ihdicate all set-back dimensions from property lines. Give street and bock number or descnpt:on according to deed, and she w street names and indicate whether interior or corner lot. APPROVED AS NOTED DATE: ~ It.~ # FEE:'~X, ~ BY' I,J. ~,L NmlFY .,~UILDING 765-1802 9 AM m ~ PM FOR THE ~OLLOWING INSPECTIONS. 1. ~OUNDATION . ~WO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION F 4. INAL . CONSTRUCTION MUST BE COMPLETE FOR;C.O ALL CONSTRUCTION SHALL THE REQUIREMENT8I OF THE N,Y~ STATE CONSTRUCT ON & ENERGY COO~8. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRoRs STATE OF NEW YORK, COUNTY or.. ~.~ ...... S.s ·.. IAI ~ ¢~-~...'-,~. .... .'~.h-).~.~.*,5.~ ............... being duly sworn, dePOses and says that he is the applicant named(Name, of individual signing contract) above He is the ........ I~.g,'P..q,,~.~7. ..... ~.~. 'o.x~ ~.~ - (Contractor, agent, corporate officer, etc.) ............................ of said owner or owners, and is duly authorized to perforrh or have performed the :aid work and to make and file this application; that all state~nents contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith· Sworn to before me this .......... ..... dayof ..... ....... 19 · ..; ... ...... County t' ~Vl, q //// // (,/ (SigniM'ure of applicant)