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Home My WebLink About19115-z 1~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- ~I1~ Z Permission is hereby granted to: ' .... · / ,~' c'~,-,c ,~.~..~ . .~.~.~ ........ ~ ........... ~....~......~. .............. ...~.. ~..~.......~..~.:.....~./.o.~..~....~.:.~-_~ to at premises located 0, ....~. ........................................................... ~.~/~/,~d.~ .............. .... ..~...~. .............................................................................. [. ............... t. ~, . ~,J County Tox Map No. 1000 Section ....... .~..I...~ ......... Block ...... J..~ .......... Lot No ......(;~...~ ............ pursuant to application dated ......... ..~..~.~<19,~.....~. ..................... , 19..~.~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL.: 765-1802 Exa,nined · · · .'~ .~..., lpc.)?. approved... 19% Permit No. J.'.%t .% Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS ~..-~LANS ..... SEPTIC FORM ................ CALL ...... MAIL TO: [ TOWN OF $OUTHOLD Date ..~ ................ 19... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Iflspector, 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. 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 applicant. Such permit shall be kept on tile premises available for inspection throuoghout 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-Dep',--,-tment for the isauancc 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 removal or demolition, as herein described. The .applicant agr. ees to comply with all appticab~'e laws, ordinances, building code, housin~ code, and regulations, and to admit authorized mspectors on premises and in building for ne~ections, d ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. a title of corporate officer) Builder's License No ........................... Plumber's License No ' Electrician's License No ....................... OtherTrade's License No.. J.~...~...1~3....~..~.~.~.... Location of land on which proposed work will be done; . . [louse Number Street Hamlet .............. ' Lot .... ~on Riled Map No. D (Name) - c .... Lot ............. istmg use and occupancy of prcm:se~ ~ntendcd use and occupancy of proposed constrnction: · l ng use and occupancy .... ~ .... ~ ......................... . · Intended , ' -- use and occunancv . ~~-~.: :~ ...... a*'? ~-...~a ..¢.:. ~ Alteration 3. Nature of work (check which appliaable): New Building .......... Addition ..................... Repair ........ [ ..... R~moval' . ........... ;. Demolition~,r.~,,...$~iranieg pool .............. Tennis Court :~ ....... AcCessory Build~,ng ....... k.._Fehee_.._.,/ ..... Other Work ............ (to be paid on filing this application} $. If dwelling, number of dwciling, unitS...,........... Number ofdwelHngunitsoneachfloor...,..........., · 6. If busaness, corem cml or m~xed ofcupancy, spemfy nature and extent of each type of use .......... 7 Dimensions of exisling structures i'f any: Front Rear Depth Height ........ ~ ...... Numbe~. of Stones .................... ; .......... ;i 'I~.~r' ' ' i ............. Dimensions of sam~ structure withlalterations or additions: Front.... .......... .- .....-....... Depth ......... ~.... ......... ]Height ..................... '. Number of Stories .................... 8. D!~ensions of entire new. construe!ion: Front ............... Rear ............... Depth ............. Height .. ~.n,~.a. ~ ...... Number of Stories .............. ; ....................................... lO. Date of Purchase ~ .~.?.~7.~.~. 'i ................ Name of Former Owner .~0~037~O-. .~A..~ ........ 1 1. Zone' or use .distric,~ ip~,~b, ic, lx premlses are situated .................................................... 12. Does proFoaed~eo~n'a'~t-~nw-m[at~ any zoning law, ordinance or regulation: . ~D ........................... Will lot be regrade~l .... 0.~..., ............. ~... Will excess fill be removed from premises: ~ · .... Phone No .............. Name of Architect .......... , ............... Address._.. ...... ~ ...... .~..~ 15.Is this proplerty located within [00 feet of a t~dal wetland? '¥E$ .... NO.~x~- · If yes. Sou~hold, Town ,{Trustees ~or~A~Mbe required. Locate clearly and[ distinctly all l~uildmgs, whether existing or proposed, and, indicate all set-back dimensions from to deed, and show street names and indicate whether' according property lines. Give stieet and block ngmber or description interior or corner lot. ~ ' STATE OF NEW YORK, COUNTY OF ................. APPROVED, AS NOTED FEE.. ..... NOTIFY 8LIILDING DEPARTI~/IENT At 76B~1802 ,q AM TO 4 PM FOR THE FOLLOWING INSPEC'UON$. t. EOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSULATION 4. FINAl,. CONSTRUCTION MUST BE COMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ................. , ................................ being doly sworn, deposes and says that he is the applicant (Name o~ individual sign iz~g contract) above nerved. He is the i . . . ) ~ (Contractor, agent, corporate officer, etc.) '" of smd owner or ow;nets, and is duly authorized to pe,rform or have performed the said work and to make and file this application; that all ~tatements cont~tined in this applic0,tion are true to the best of his knowledge and belief; and that the work will be performed in the manneir set forth in thc application ~lcd thcre~vith. ' / S~vorn to before mc this ,