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Home My WebLink About19153-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_* 19153 Z Permission is hereby granted to: ,....g,,,~~....~.:.~.....,o~./.~...~. ........ ,c-~ · ,,-I/ ~ , . ....... ............ at premises I~ated at ....~..~......~.~..~,~ .............. ~~~ .......................... Coun~ Tax Mop No. 1000 Section ....... ~.~.~. ......... Bilk ......~.g. .......Lot No, ...~.~ ............. pu~uant to application dot~ ........ ~...~.~ ................. , 19.~.~.., and approv~ by the Buildln~ Inspector, Building Inspectar Rev. 6/30/80 FORM NO. 1 TOW~ OF ~OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHoLD, N.Y. 11971 TEL.: 705-1802 Examined .. Approved.. Disapproved alc ... uilding Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANs SURVEY SEPTIC NOTIFY: CALL Date .. i ...... ~ 19.. INSTRUCTIONS ,,it . a. This application must be completely filled in by typewriter or in ink and submitted to the Buildin~l~Pector, 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 Npan of th, is appli- cation. c. Thc 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. ' shall be kept on thc premises available for inspection througJmut the work. Such permit e. No building shall be occupied or used in whole or in part f`or a.ny purpose whatever until a Ce~tific~ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu/Iding Permit pu/~uant to the Building Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Law~. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for i:cmoval or demolition. = t~ae~in descr/bed. The applicant agre~ to comply with all applicable laws. ordinances, building code, housing code, and r~alations, and to - . (Signature o£ hPplicant, or nam e; if'a'c'o~l~o'r~l;~o'n')' ' ' (Mailing address of applicant) State whe'ther applicant is owner, lessee, agent,' architect, engineer, general contractor, electrician, plumber or builder. '..-h.;- · w rp se . -~-~ e.c.c.e.q . ~.~.. ~. . (as on the tax roll or latest deed) ................. If`applicant is a corporation, signature Of duly authorized officer. ........ iffa;~i;~a i/ti/;~'~;;~;;a;; ' officer) ~uilder'~ ~.ice.~e ~o .... /~..~. 2.Z~. ....... Plumber's License No .................... Electrician's License No ....................... Other Trade's License No ...................... [. LOcation of land on which proposed work will be done; ~.~o~ ~.,~= strOLl .......... v ................... ~.. ........ Hanllc * - ,~T~ .~: ,ooo //4 ' - Coun x Ma o Section .............. Block ........ u vision ..... · · · ,. (Name) ..... Riled Map No. ... ,; State existing use and occupancy of premises and intended use and ocan-a~ · 3. Nature et work (check which apphcable): New Building .......... Addition .......... Altcratmn .,,-.,.; ....... Tennis Court .'.'.'.'. ~.,. tsccessory Bu,.id.tag .......... Fence ...... Other ~. . 4. Estimated Cost . i Fee ~ (to bc pa:d on l~hng, thlS~pph~a~ti:on) .5 Ifd I1' b fd Iii I . N · we lng, hum ere we ngumts .......... ; .... umberofdwellingunitsoneachfloor ............... If garaee number of cars ' 6 If business commercial or mixedioccupancy specify nature and extent of each type of ...... 7. Dimensions of existing structures~, if any: Front ................ Rear ............... Depth .............. Hei,.:ht ............... Numl~cr of Stories ., . ~ ................. Depth ..................... !. Hci ,~ht ...................... Number of Stones 8. Dimensions o entire new constriction: Front ............... Rear .............. e . Height Num6er of Stories 9 Size oflot: Front ~ .............. · '- ... · · ..................... Rear ...................... Depth ................ 10 Date of Purchase j .... .............................. Name of Former Oxvner ............. 11. Zone or use district in w~ich premises are situated. ' ...... t2. Does proposed Construction viol tc any zoning law, ~i[n'a~'ce o'r'r~ ;a't iD n':' .::: ' ~::'o'~ 'prem es: yes--- ::: ': :' :" :::: ~:: "' 13. WLIllotberegraded .: ..... .. ..............' .... Will excess fill be removed is .No. 14. Name of Owner of premises .................. Address ................... Phone No .... Name'of Architect .......................... Address .................. . Phone No ................. Name of Contractor · ........................- Address ................... Phone No ..... ,% .......... IS.Is this property local ed within lO0 feet of a .tidal wetland? *YES .... NO .... · If yes, Southold Town Trustees 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: umber or description according to deed, and show street names and indicate whether fntcrior or comer lot. STATE OF NEW YORK, COUNTY OF ................. NOTIFY BUILDING DEPARTMENT AT 76,5-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS, 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4.. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C,O ALL CONSTRUCTION' SHALL MEET ............................ ' .................. being duly T E N,Y · (Name of individual signifig contract) above named· ! . CODES, NOT RESPONSIBLE FOR ' ' ' DESIGN OR CONSTRUCTION ERRORS He is the i ' (Contractor, agent , corporate officer , etc. ) ' of sa|d O~vner or owners, and is duly] authorized to pc,Florin or ]lave performed thc said ~vork and lo make and file this. application: that all statements contaii:ed in lifts application are true to the best of Isis knowledge and belief; and that the work will be performed in ti e m:mner,'sct forth in the application filed therewith. Sworn tO before mc this I ............. ~. ......... day o£.; ......' ....... 19 7?. ,'o,ar¥,,,,b,,c ...... ........ ount N~TARY P0ett~ ~ a ~ ~ · - ~. 4707878, S~k ~u~/ T~ ~p~r~ ~h aO, ~ (Signature of applicant)