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Home My WebLink About19352-z ~O~,~r NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ,735~. Z , .....:>~..~~...,...~,.~ ............ ~o..~~....~..~. , :>.~,,~ b,'~? ..~_.~~ ~ ....... .................................................... at premises located o/~t ...,,~..Z~ ,~.........~**~~/-***~> .................................................................... · . ~m:',~ County Tax Mop No. I000 Section ....Z.~.,~ ..... Block '"'Z' ............Lot No...Z,,~*,~,'*Z. .... pursuant to application dated ......... ~.,'~....~.... ........................ , Building Inspector. Fee ....,,~ 19.~.~.., and approved by the Rev. 6~30~80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK .... f/.,~ .~. TEL.: 765-180~ Examined .............. , 19._.~- .... .... Disapproved a/c ..................................... ~uild~nsp~r) / APPLICATION FOM BUILDING PERMIT MOT~FY~ MAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 l~yout of property must be drawn on the diagram which is part of tiffs appli- '~eation. . o. The work covered b~, this application may not be commenced before issuance of Building Permit· , d. Upon approval of this application, the Building Inspector will issued a Building Pcrmit to the applicant. Such pea'nit shall be kept on tile premises available for inspection througdmut the work. e. No building shall be occupied or used in whole or in part for agy purpose whatever until a Certificate of Occupancy shall have been granted by thc Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance o£ 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. (Stgnature ct applicant, or nonce', ~f'a'~orI~or~[idn')' ' ' ·..~ ' '~, ..... , · , . , (Mailing addrdss of applicant) State wh~ther applicant'is"'!6~wner, lessee, agent, architect, engin, eer, gene¢l con.tractor, electrician, plumber or builder. Name of owner of premises ' (as o~ the tax roll of.latest deed) It' applicant is a corporation, signatur~ of duly authorized officer. (Name and title of corporate officer) Builder's License No...~./~..'.~..~-.~,C..~;..,~...t~.; ..... Plumber's License No ' Electrician's Licens~ No ....................... Other Trade's License No ...................... Location of land on wiffch proposed work will be done: ................. ', llouse Number Street Hmnlet .......... County Tax Map No. 1000 Section ................ Block .................. Lo ......... Su vision ..................................... Riled Map No. Lot .. . (N ) ' · '" State existing use and occupancy of prenuses and Intended use and. occupancy of proposed construction: A. Exzstzng usc and occupancy.__ ............. ~ ................................. 3. Nature of work (check which applicable): New Building .......... Addition ..... ,'e ~ · · ~r~il~l~18. · ,' ;,' .... Tennis Court ......... Adcessory Building ........ Fepce '.v~. .... ~Q[.~.~oa~.~.~.~_r~;'j.~;~..o 4. E 5'0~ ....... Fee .......... *"!.b.,4.~.,.. {0 1 .~...~.~ st:mated Cost... } ........ ~ ., ............: ,~ ~ : (to be paid on filing this application} .~If dwelling number of dwelling u4its Nnmber of dwelling units on each ................. floor ,~,~"Dimensions of existing structures,lif any: Front .............. . Rear ............... e ....... Nu nber of Stories Heieht ................ Dimensions of same st.m. cture ,.vittl alterations or additions: Front ................. Rear...] ..... ]~]]]]. ,. Depth .................... ,. Height ..................... Number of Stories ............ ~ Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Nub' fst ries ' ::: : : /Height ............... , m ,'er o o .... ~ .................................. pth i ......... (9. Size of lot: Front ............ ~ .......... Rea ..................... De ............ 10 Date of Purchase ~ Name of Former Owner 11. Zone or use district in which prermses are situated .................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: ................................. 13. Will lot be regraded ......... i .................. Will excess fill be removed from premises: . Yes .... No.. ' Phone No 14 Name of Owner of premises i Address · .....''" ..... '' Name of Architect Address .. Phone No ................. ' ' Address Phone No Name of Contractor ., · · .- · · ..' ................. 15.Is this property located within 300 feet of a tidal wetland? *YES .... NO .... · If yes, Southold TowniTrustees Permit may be required. , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from~. property lines. Give street and block riumber or description according to deed, and show street names and indicate whether' interior or comer lot. ABPROYED AS NOTED DATE: ".R N OTl1~y I~UILOIN G_ D E PARTMyJq/T 'do, I 765-1802 9 AM FOLLOWING INSPEC~ONS: 1. FOUNDATION - ~0 REQUIRED FOR POURED CONCR~E 2. ROUGH - ~RAMING & PLUMBING 3. iNSULATION 4. FINAL .- ~ONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHA~ ME~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIBLE FOR STATE OF NEW YOR~ESIGN OR ~TRU~ION ERRORS COUNTY OF ................. , . (Name of individual sig¢ing contract) APPROVED AS NOTED DATE: _ .. B.R # - 76&.181112 9 AM ~ 4 ~ FOR ~E FOLLO~G ~NSPECTIONS: 1.FOUN~TION - ~0 REQUIRED FOR PO~ED CONCRETE 2ROUGH .~RAM]NG · PLUMBING 3. INSUL.ATIO~ 4. FINAL - ~NSTRUCTION MUST BE COMPLET~FOR C.O, ALL CONS~4UC~ON SHALL MEET ~ATFr CONS~T~N & ENERGY ~?or~'S NOT RFSP~NSIBLE FOR ~ CONg'rRUC~ ERRORS being drily sworn, deposes ~d says that he is the applicant above named. H-e is the · ' ' (Contrai:tor, agent, corporate officer, otc.) of said owner or owners, and is dt!ly authorized to pe,rform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann!r set forth in the application filed therewith. Swam to before me this ; ] ~":~ '~/~ ~ --~ZZ~. ~ , · . C:~ , . . day Of..~ .,19... ........... Notary Public .... '. . County ~-~, ~ 8L '~1, ~mr ~ld~ ms a .~= .~ ~, ~,i~. .... / .............. ........ No. 4952246, Suffolk Coun..ty · ~lt~rll~[~1~- . Term E. xplre8 June 12, 19Z~L 16.7B6 ACt~P~ ~