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Home My WebLink About19205-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) N9 ,~2P~. Z ............. ......... 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 BLDG. DEPT. TOWN OF SOUTHOLD .... ' :~. 9 ~ TEL.: 765-1802 Examined....... , I . Disapproved ale ................................ FORM NO. 1 TOWN OF gOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTItOLD. N.Y. 11971 BOARD OF HrALTH ............ 3 SETS OF PLA,blS ............ SURVEY ..................... Ctlrclt ...................... SEPTIC FORH ................ APPLICATION FOR BUILDING PERMIT Date .... ~ ........ , l.~ INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Buildinc ~ector, 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 par[ of this appl/- ¢. The work covered by this application may not be commenced before issuance of Building, Permt · d. Upon approval of this application, the Buil-~:-,, ' ...... , - ' ' ' ~ 't. · ' u-h, inspector wm lssuca a L~uilding Permit to the applicant. Such permit shall be kept on the premises available for inspection throuehout the work. e. No building shall be occupied or used in whole oran part for any purpose whatever until a Cer~ific:~ of Occupancy shall have been granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu/Idlng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable La~s, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for femoral or demolition, ~s herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housina code, and rcgm~tions, and to admit authorized inspectors on premises and in building for necessary ~ ' · "'(gi~a-t~r'e'~/'~;;~' ~7 ~F:; ...... ,,... State whether a,~licant is ~w,~,- ,,-~.~ . ~. ........ , ...... , agent, architect, en~'ineer ,,e~o~aL;~h,.,;~d_,/_2,~2~_.. · ........... . · 1..ff.'?'JF.~t'. /... O ....... · ~. ( s on thc tax roll or latest deed) If applicant is a co~oration, signature of duly authorized officer. a e n e officer) Builder's License No ................ o Plumber's License No ........................ Electrician's License No. O/her Trade's License No. : 1. Location of land on which proposed work will be done; ' ' :-' "' ........... o ~ d .s';¢ /- ~ ¥ · · ................. ~ Z. . . :. .m.. .~. .tT.. ., P,, ~_./ c >. ......................... & . .lQ .. . [louse Number ' Street Hamlet .......... CountyTax MapNo. I000 Section /~tz( '. ' BIo ~ ~,, .................. ck ..... Lot . ..~..~, ..... ~,... Subdivision ................ . ' · · ';. ..................... F..iled Map No. . (Name) ............. Lot ...... State existing usc and occupancy of premises and intended use and occupancy of proposed constructiom ' -. E.,,s,,n~ use a.d occupa.cy ..... ~.4.~... ~.~..~,/.~.....~."x: ~,.. ~,~.o ' b t .... , '-'~ ' n ~'q~.~.,~'h! ..................... " 5. welling, number o xvt ng units ....... , . · tmbcr of dxvelling units on each floor ........ ara=e, number of cars ...... : ......... 6. If business, commercial or mixed Occupancy specify nature and extent of each type of use .. ~ .............. 7. Dimensions of existing structures,ltl any: Front ................ Rear ............... Depth ........... Heieht. . Numbi,r o f Stories Dimensions Bt' same structure witll alterations or additions: Front ' ................. Rear .............. Depth ..................... I. Height ............ Number of Stomcs ............. D. . ..... iii ...... 8. uncnmons ofentirc new constru on: Fron ............ Rear ............... Depth ...... Hcigttt .Number of Stories ..... 9 ~ize of lot: Front ' Rz a Deptl~ l0 Date of Purchase , ......................................... · · ...... I Name of Former Owner 11. Zone or use district in which pren~ises are situated "Does proposed Construction violaia any zoning la,'v .... ; ............... "i"~"~' i .... ~' . ordinance or regulation 13o ~Villlot be regraded o: . .. ~ ..... ......................... Will excess fill be removed from premises: Ye~ .... N~ ... I; Name of Owner of premises [ .' ..... Address Phone No Name of Architect · ·. Address ...... Phone No ...... tqame of Contractor .......... 15.Is~ this property located w~thi~ I"O0 feet of a tidal wetland? *YES .... NO.-~- -' · ~f yes, Southold Town iTrustees Permit may be required. . ~ PLOT DIAGRAM Liocate clearly and distinctly all Buildings, whether existing or proposed, and. indicato all set-back dimensions from prop{rty lines. Give street and block n~mber or description according to deed, and show street names and indicate whether- interior or corner lot. Nature of work (check which app!icable): New Building., ......... Addition .... ~ ,,...,Uteratlon .......... '.4 Repair .............. R~moval .............. Demolition ...... i,~,~ ./~l. Pr¥~ mini h; 'Got .......... ITennis Court .~,. ,~,, ....... ' · '- · .~-- ,, P · ' I '.~/ ~ .... ~ssory nuz~.aJ, ng .......... Fenc'e ..~ ..... Other Work ............ (to be paid on filing this application) APP OWl) ASINOTEO NOTIP/ BtJIED/I~ OEt~ AT 765.1802 9 AM TO 4 PM fOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REOUIRED FOR POURED OJONC~RETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION /, ~ 4. FINAL - CON~TI~UCTION MUST BE COMPLETE FOR 'C.O. ' ALL CONSTRUCTION i SHALL MEET THE REQUIREMENTSI OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NE~V YORK, S;Si COUNTY OF ................. ............................~ · · I ................. · · being drily sworn, deposes and says that he is the applicant 'i . (Name of individual signinlg Contract) above named. He ~s'the ,I ~ (Contractor , agent , corporate officer , ete . ) '' ......... of sa d owner or owners, and is duly)mthorized to pe,rform or have performed tile said work and to make and file this application; that all statetnents contained in this application are true to the best of Ilia knowledge and belief; and that the Work!will be performed in the manner ~ct forth in the application qlcd therewith ..... Sworn this ' to before mc , ................ .. .... :'... OLD 0 0 TI 0