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Home My WebLink About19024-zTOWN OF SOUTJ'IOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: _ . , ..~.~..~.~....j.~.m..~ ..... .... ...... ...................... .~~.~.....~.....~,.....!.!..~. .~..~. .............. .~...~t~, o ~ . . 0~. ~ ..... to ..~ ........................... ~ .............................. ; ....................... nt premises located at ..~.~..-~..........~...~....q~..~.~,,....J~-~.., ........ ,~drR~.~~ ............... County Tax Map No. 1000 Section .......... I.!./. ......... Block ...... ,0....~.. ....... Lot No ...... I..~.. ............. pursuant to application dated ................ ....~.......~,~..~. ................. , 10.~..~.,, and approved by the Building Inspector. Fee $..A.~.:..~... Rev. 6/30/80 13 Willl tb d d Will ~'fillb dfr i Y ' · o e regra e ...................... ~ ..... exces e remove om prem scs: es 14 N of Ow fp is Add PI No ' · amc net o rem es ....... ress ......... ~one ............ : . .. Name of Architect Address Phone No ' Name of Contractor ................. i .. .......Address ................... Phone No ..... 15.Is this propert~ located within !00 feet of a tidal wetland? ~YES .... *If yes, Southold Town Trustees Permit may b~ leaqu£red. '. PLOT DIAG I1AM I. ocate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or deseription according to deed, and show street names and indical~e whcther~ interior or corner lot. ,~ STATE O F NEW YORK COUNTY OF ' . S.S ............... .......... · " '--' .-.- --....- ... ... being duly sworn, deposes and says that he is the applicant · (Name of individual signing contract) above named. lie 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 t~erfom~ed in tile manner set forth i. TOWN OF ~OUI'HOLD ~ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL,: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY .., .................. CHECK ......... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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- c, ation. 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 to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for i'emoval or demolition, as herein described, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit aut, horized inspectors on premises and in building for necessary inspections. ~,//~,'~///~//~/r~, ' . · .... ( ailino adflress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... *," ............................................................................... Name of owner of premises abJ~.7~.//~..J~..~.'.2~. [/}~-~/~a~ ~.t /]~Z d/~/{.~.~.,~f (as on the tax roll or latest deed) I£ applicant is a corporation, signature of duly authorized officer. Plumber's License No ' Electrician's License No ....................... ' Other Trade's License No 1. Location of land on which pro, posed work will be done; . ...... .... ..,. House Number ~ Street, APPROVED AS NOTED N~I~ 8UImlN6 DEPARTMENT AY 765-1802 9 AM ~ 4 PM FOR THE FOEOWING INSPE¢IONS: 1. ~UNDATION - ~O REQUIRED FOR POURED CONCRETE 2. ROUGH * FRAMING & PLUMBING 3, INSU~TION 4,. FINAl. CONSTRUCTION UUST 8E COMPL~E FOR C,O. .... ALL .CONStRUCTIOn. ~HALL, MEET THE REMENTS C~ STATE CONSTRUCTIOI~ ..~ ENERGY County Tax Map No'. I000 Section ...... /~./...71 ..... Block ........COP.E.g...N..OTLo'atE,S.P.~...N~. LE FOR DESIGI~ OR CONSYRUCTI~)[~'E~Fb~ORS ' "~' ' ' Subdivision ..................................... Eiied Map No ............... Lot ............... (Name) 2. State exist'ng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy · ntende Use and occu anc .......................... ... , ?;, , P Y -- . -- . ~.,[~ :',. ,;, Alteration Nature of work (check which applicable): New Building Addition ........... Repair ........ .... ' R~mov~l ............. Demolition .... .~. ..... Swimmiqg:,,: '~ ,~ ,~P°°M; ,~,'~ ............ · Tennis Court .... : ~ . . . Aelcessory Building .......... Febce,.~ ..... Other Work; ........... 4. Estimated Cost .......................................................................' ; (to be paid on filing this application) $. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................. If garage number of cars ~ .................................... 6 If b d o ify d typ .... · usiness, commercial or mixe ccupancy, spec natnre an extent of each e of use ............... ,:if any: Front Rear Depth 7. Dimensions of existing structures ............................................ , Height ............. .. Number of Stones ...................................................... D~mens OhS of same structure wtth Iterations or additions: Front · ' ' a ................. Rear ............... ' Height ...'. Number of Stories Depth ........................................ ' .................. 8 Dimensions of entire new construction: Front Rear Depth ..... Height ,Number of Stories · 9 Size of lot: Front Rear Depth · Date of Purchase · Name of Former Owner Zone or use district in which premises are situated 122 Does proposed constructionviolafe any zoning law, ordinance or regulation: ..................... · .......-. "' ad ~ Wiil fill N 13. Will lot be regr ed ......', . ........ ~ ............ excess be removed from premises: . Yes :' Phone No 14. Name of Owner of premises ...................., Address .................................... Name of Architect ........................... Address ................... Phone No .................. Name of. Contractor .................. i ........ Address .......... Phone No ..... ~ ......... 15.Is thxs property iocatled within 100 feet of 'a''~i~'a'l' wetland.* *YES .... NO. ~*If ,y~s, 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 fi'om property lines. Give street and block number or description according to deed, and show street names and red,cate whether. interior or comer lot. STATE OF NEW YORK, ' .'v S.S~;~~- COUNTY OF ................. ' ~ '." ' '~, ' bei gdt ly d poses and s y that he is the applicant _. (Name ofihdB'idtlAl sl=arfi[~g:contract) · : ' (Contractor, agent, corporate officer, etc.) of sa d owner or ,owners and ~s du, y authorized to pe,rform or have performed the said work and to make and file this application; that all .statements coats_hied, m tins apphcatmn are true to the best of his knowledge and belief; and that the work will be performed lathe mgnne~r set forth in the application filed therewittt. Sworn to before me,this [~ ............. .. ........... day o . ..... (Signature of applicant)