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Home My WebLink About19022-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWb~ HALL SOUTHOLD, N. Y. BUILDING PERJ~dT (THIS PER~IT MUST BE KEPT ON THE PR£MISE$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 19022 Z Permission is hereby granted to: ~..~.~.~t~.~.....~.~ ............... ..z.~.~..,...~.~..~, ............................ ..~..~;~U~..'..~,.,.~,.,. ...... u..~.~..~ ......... ............................................... at premises located at ..~;~J~ ....... ~:~.~........~. · ..~....., .......... ~~..~ ............... County Tox Map No. 1000 Section ......... .J.~..~.~ ....... Block ...... ...~,,,,'~,, ...... Lot No......~.....~ ............ pursuant to application dated ............ ~.~...~. .................. , Jg..e/.P..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 ~,~ 0 ~ : Approved....~...~ .f.~...., 19 ~.~. Permit No..J. ~.0..~..~...~ Disapproved a/c ..................................... ~INO. 1 !EPARTMENT HALL N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEPT c';; ................. NOTIFY: CALL MAIL TO: ..... · (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building I~spector, 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 layout of property must be drawn on the diagram which is parr of tkis 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 will 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 tb the Building Department for the issuance of a Btrliding Permit p~arsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otlaer applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. The applicant agrees to comply with all applicab"le laws, ordinances, building code, housin~ code, and reg~ations, and to admit authorized inspectors on premises and in building for necessary inspections. .¢// / - t o t appficant or name ifa corporanon) (Mailing address of appiicm~tt) State whether applicant i~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title o orporate r) Builder's License No ..... /~'/'~. ............ PIu be L' N ~n rs cease o ........... ~ .............. Electrician's License No ....................... Other. Trade's License No ...................... 1. Location of land on which proposed work will be done; House Number Street. ' ............. Subdivision Eiled Map No ~ (Name) 2 State e-' , · · XlStmg use and occupancy of prcmlses and Intended use and occunan .,, ^e ........ , _ . .. A. Ex~st~ng use and occupancy ....... W~C/~/~.x,<~,, ~/~.~%~,.~ .).% ...... ' ................. B Intended use and occupancy 3. Nature of work (check which applicable): New Building ........... Addition .......... Alteration ........... Tennis Court ,~ ..... Accessory Building .......... Febce . Other , (to be paid on filing this application) $. If dwelling, number of dwelling unitk ............... Number of dwelling units on each floor ................. If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7 Dimensions of existing structures it'any: Front · Rear . :Depth Height ............... Numberlof Stories ....................................................... Dimensions of same structure with alterations or additions: Front Rear . . Di:pth Height Number of Stories . 8 Dimensions of entire new construction: Front , Rear Depth .......... Height Number of Stories ',~ · ' · · · · 9 Size of lot: Front Rear Depth 10 Date of Purchase Name of Former Owner ....... 11. Zone or use district in which premises are situated ................................................... 12 Does proposed construction violat~ any zoning law ordinance or regulation: · 13. Will lot be regraded ........... ! ................. Will excess fill be removed from premises: . Yes ,.. ~ No. ' . ,' .... Address Phone No I4 Name of Owner of premises ' · ................ Name of Architect Address Phone No · - Name of Contractor ........... i. ..... i .. .......Address .......... Phone No ..... 4 ...... i .... 15.Is this property located withxn tOO feet of '~ ~id'a'l' wetland? *YES...'.NO .... · If yes, $outhold Town Trustees Permit may be required. i 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 n~ tuber or description according to deed, and show street names and indicate whetlie~'~ interior or comer lot. APPROVED AS NOTED NOTIFY BLJILOING DEPARTMENT AT 7654802 9 AM TO 4 PM FOR THE ~OLLOWING INSPECTIONS. 1. FOUNDATION IV~O REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUM~ING 3. INSULATION 4. F~NAL CONSTRUCTION MUST 6E COMPLETE FOR C.C. ALL CONSTRUCTION SHALL MEET STATE OF NEW YORK. ,S.S THE REQUIREMENTS OF THE N.Y. COUNTY OF ................. STATE CONSTRUCTION & ENERGY ............................ ~ .................... being duly w O SI LE FOR (Name of individual sigqing contract) above nar~ed. ' Pre is the ..................... ; ..................... ; .......................................... :.. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 manner set forth in the application filed therewith. / Sworn to before me this ................ ....... d. y .....22t..a . .......... 19 Yq Notary Public .......... Q. .......... County , , . HELEN NOTARY fq. IBLIC, St~e . Iio. 4707878, S[lffolk count.., (Signature of applicant)