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Home My WebLink About19197-z FO~ NO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLDo N. Y. BUILDING PERNilT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) _ ......... at premises located at ....~'.~...~..~-.~.~-~.~...~../,..~ ............................................. County Tax Mop No. 1000 Section ....... ./...~:...~.. ..... Block ........ ~.. ........ Lot No ........./.~. .......... pursuant to application dated ....... .~'../..../...~.. .................................. , 19.~...~.., and approved by the Building Inspector. Fee ~... ~.~.~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Examined .......... 19,, Approved .......... 19 Permit No. . Disapproved a/6 ........................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ........ ~ ............ CHECK SEPTIC FORM NOTIFY$ CALL TOi · MAIL · A IT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Ihspeetor, with 3 sets of plans, accurate plot plan t0~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 tiffs 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 wi/l 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 Sduthold, 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. TOe ,applican,t agrees to comply ~.v,~,h> q!!,~;~plicab~e laws, ordinances building code, housing code, and regulations and to admlt authorized inspeoJ~t~,~l~h ;l~refi~is~s~,~ffd, in building for necessary insp~s. ~ ~ ~ ' ,.. , ~ ..... ; ' . (S~gnature ot applicant, or amc ifa cor oration ~ta[e whether appheant is~!oW~le~r,,lessee, agent, a~ch~tect, engineer, general contractor, electrician, plumber or builder. vdtgg ~ )D'~ ............. , , , ,, (as on the tax roll or latest deed) :f applicant is a covp~raei~n,,.srmaa[u[e~of~di~.ly~autht~Fized officer ~a~e ann"title OI co.orate officer) Builder's License No .......... Plumber's License No ....................... Electrician's License No ..................... Other Trade's License No ...................... · Location of land on which proposed work will be done; . . !louse Nun ber rcet, Halnlet ty · 8 /6 Court Tax Map No. lO00 Section .............. BrOck ........ ,~ ........ Lot ", Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) , State existing nsc and occupancy of premises and intended use and occupancy of proposed constrnction: A. Existing use and occupancy..:;~.. . ''''. ......... ~':'[[ ..... . V ......t .......... .....,' '" ....'-t'.' '. ...... :. } N~ture'ofwork (check which applicable): Ne~ Building Addition Alteration Repair ....... ' v · '' Swimraing pool ............ ....... RLemo al.. ............. Dcmohtmn .......... Tiennis Court; ......... AcCessory Building .......... Fer~ee · .~..Of:her Work ............ ~. E~stimated Cost . ....' , Fee · , :~ : (to be paid on filing this application} L If dwelling, number of dwelling un[ts ............... Number of dwelling units on each floor ........ I~ garage, number of cars ....... ! ....................................................... 3. Ifbusness. commercial or mixed oCcupancy, specirynatureandextentofeachtypeofuse ';2;ii!i 7 DI' ' ' structures il'any: Front Rear ........... · m~ens~ons of existing, , ..................................... H.e~ght ............... Number o f Stories ................................. ..... ii .......... D~mensmns of same structure w~th glterations or additions' i , . ron .. ., ..... Rear .... . ........ , Depth ...................... ~Height ........ u of Stories ........... ~ Dimensions of entire new construction Front. - Rear Depth H~ei~ht Number of Stories ' · ' ' : Slze of lot: Front ' Rear Depth · Dlate of Purchase ............. ~' ........................................... ' '"'' ' 3 Name of Former Owner Zbne or use district in which pram ies are situated Does proposed Construction violate, any zoning law, ordinance or regulation: . ~.0 .......................... 3. Wlill lot be regraded ..... /~O.. ................. Will excess fill be removed from premises; ~ Yes .... Ns.. 4. N~ame of Owner of premises ~6/1,).~./-~...~.../~ .' .... Address .-..~o°../~~. ~/,.J._/~.~.P/. ~./-P. hol~.l'~o¢~.) ~-~,o°.'/'.:/~ 71... Name of Architect ........... ............... Address ........ .~..t?.~ .J~.'~..~h~Zn~tl(Io ................. Niame of Contractor : ' Address Phone No ' .5.I~ this property lo~te{d within 300 feet of a tidal wetland? ~YES.~/..NO .... · I!f yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Lo,cate clearly and distinctly.all bgildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description accord~g to deed, and show street names and indicate whether lteriq'r or corner lot. ;TATS' OF NEW YORK, ~OUNTY OF . APPRO¥ / ) M NOTED ,,~-~UOZ 9 AM ~ 4 PM ~OR THE FOLLOWING iNSPEC~ONS: I. FOUNDAT~N , ~ REQUIRED FOR POURED CONCR~ 2. ROUGH. F~ING & 3. INSU~ON 4. FINAL CONSTRU~N MUST BE COM~ FOR ALL CONSigN 8~ ME~ ~E REQUIR~E~ ~ ~ N,~ STA~ CONS~ON ~ ~ERGY CODES. N~ R~NSIB~ DESIGN OR ~~ s.S ..... i .......................... ' .......... · ....... being dnly sworn, deposes and says that he is the applicant , (Name of individual sigmng!contract) bore ~am'ed., ~e is tim ' . ] ,~ (Contractor, agent, corporate officer, etc,) T sa~d owner or owners, and ,s duly authorized to pe,rform or have performed the said work and to make and file this ~phcanon: that all statements contained m this application are true to the best of his knowledge and belief; and that tt~e /ork will be pertbm~ed in the manner set forth in the application filed therewith. ,worn ltd before me this ...: 0 ' ........... , ' 'i .......... /" ....... day of. ! .o,a uh,,c ....... ....... oun. H[1.EN K. DEVOE : NOTARy pij BLIC, Stalel~f~leWur~ plican. ) I~. 4707878, ~uffc)