The URL can be used to link to this page

Home My WebLink About19330-z FO~ NO. ~ TOWN OP $OUTHOI. D IUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (TH~S PERMIT MUST BE I~EPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Mop No. 1000 Section ......... ..~.. ......... Block ....... ~ ..........Lot No. pursuant to application dated .... ~ ........ l~.. ......... , 19..,~/.~/, and approved by the Building Inspector. Rev. 6/30/80 FOUNDATION {1st) FOU~DATIO:; (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FI:;AL ADDITIONA'L COMMENTS L Examined ................. 19 . .. ,,pproved. f Permit No../.q..,'7. 2_' Disapproved a/c ...... BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY TOWXl OF SOUTHOLD CHECK .......... BUII~D,INGDEPAFITMENt SEPTIC FORi-I TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 MAILCALLTO'': .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .... ~.. A.d. a. Th/s 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. ¢. 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. 1~. ' ' 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 Regt/lations, for the construction of buildings, additions or alterations, or for removal, or demolition, as herein desar/bed. 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 inspect39ns. // ~, ~ (Mailin, address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ( n the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... ............. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE S~FOLK COUNTY LICENSED Builder's License No .... ~.45:~/../.~ ............. Plumber's License No ......................... Electrician's License No. o~- ~. Other Trade's Uccnsc No... W.¢. ~.~. .......... 1. Location of land on which proposed work will be done~ ' H N b St H I .......... ouse um er feet am et lO00 S c,on ........ ............... ............. County Tax Block . Lot ,,. Subdivision Filed MaI3: No: ..............................................' '" · · Lot ............. (Name) · ' ~. State existing use and occupancy of premises and intended use and occuPar, cy of proposed construction: a. Existing use and occupancy ' ~ ' ' b. Intended use and .~.~q~ occupancy ....................... 3. Nature of work (check which applicable): New Buildin~ . .. ' .......... - , . ~ep= ..... 'F ...... Kemoval ........... .... Demolition .............. O~ Work.~ ' (~o be paid on ~]Jng this appiica{ion) s. ir dwelling, number of dwellin units ............... Number or dwelling units If garage, number of c~ ' on each floor .... 7' Di~ . Comme a or m~xe. ccupnncy, specify nature and extent oreach type of use .... sions of existing st~cm {s irony: F . en r , root ............... Rear D H igl N n~ber fSt ~ ............ ... cpth . D~ensions ors ~itl alte alions o addit~ .... f ............................................ amc structure w ~ r r oas: root ................. Rear .................. 8 --' ' ' ' ' ~' ' ne~t .................... Number of Sto~es ............... Hight Njb fSt fi 9 Si fl F ' ' ' ................. . zeo ct: font ........... ~ ........... Rear: ...... 0 D of P ............... Depth . ate urchase ........... ~ ....... N of Fo~ O ...................... I. Zone or use district in which prgmises are situated ........................................ 2. Does proposed construction viollate any zoning law. ordinance or re-ulation: ' s. ... - . ............... ~.~ ~e ~ .... ' ' .. ~ ~7~' ~2 .....~ ...... *wu exc~s~ fi Ibc removed from premises.Yes N~e of Architect ..~ .... - ~ .... ~. ~= -~= p~uperty xocatea wxthln 300 fact of a t~dal ~atland? ~Yes~. .... No ..... .~ ~lf yes, SouthoXd To~ Trustees Pe~t may ba reoulred. .. ... ~ PLOT DIAG~M Locate cle=ly ~d distinctly ~1 [bu~d~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from rope~y ~nes. Give street ~d block ~umber or description accordNg to deed, ~d show street n~es and indicate whether ~xeNor or comer lot. ?ATE OF NE O.R,K _ _!_ -- ' .... ~... ~O~1~.. ,~... ~ .... being duly sworn, deposes and says that he is the applicant . (Name of nd ~:~uai ssgmn,g contract.) ore named , is the ~~~ .... ~. (Contractor, agent, corporate officer, etc.) said owncr or owners, ~authoHzcd to perfo~ or have peffo~ed alicadon: tha~ all statements contained N fids application are true to the best of his knowledge and belief; and that the ,rk will be perfo~ed in thc mmme~orth in the application filed therewith. . · om [o before ~e this ..... t · ...... " D .................. County OUl,~ I~ 5uttOIk ~unly (Signature of applicant) Term Explrei 12/~