HomeMy WebLinkAbout19051-zTOWN OF SOfT, OLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHO~D, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N*_ 17051 Z
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at premises located at ...~..0..~...o..........~..~.....~...~.., ............. ~.~. ....................
..... ...........................
County Tox Map No. 1000 Section ....... JJ..q. .......... Block .....(~....-~-.. ........ Lot No ...... ~..~. .............
pursuant to application dated .......... .~.~.J....~J..~. ...................... , J9.~..9..,
Building Inspector,
and approved by the
Building Insl:~:tor
Rev. 6/30/80
/,
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.' 765-1802
Examined .. · ~Od[..~ ~, .... 197.O.
approved .... · 19 .0. Pc=it
Disapproved a/c .....................................
BOARD OF HEALTH ............
3 SETS OF PLANS ............
SURVEY .....................
CHECK
SEPTIC FORM ......
NOTIFY'
CALL .....................
MAIL TO:
.O,.v., ?Cf ..........
/f .Z.
(Building Inspector)
APPLICATION FOR BUILDING PERMI
Date .lYf.ay. ].6, 1990
INSTRUCTIONS
a. This application must be completely filled in by typewriter orin ink and submitted to the Building Ihspector, 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 part of tkis appli-
cation.
¢. The work covered by tkis 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 the Town of Sou(hold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, a.d, ditions or alterations, or for removal or demolition, as herein ~escribed.
Th~ applicant agrees !o comply with all applicaffe laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
Ron Morizzo builder, Inc.
· (~ig~tat~re'of]lpplic~nt, o~ name', if a corl~o'r.~rlc~n') '
P.O. Box 789, Southold, NY 11971
(Mailing address of applicant) ....
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General Contractor
Dale & Kay Falcinelli
Name of owner of premises ...........................................................................
(as on the tax roll or latest deed)
If applicant is a,..~rporation signature of duly authorized officer
(Name and'titie' ;~SYr~o~a~e ;fficer) ' ' '
Builder's License No. 6772 HI
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No '
Location of land on which proposed work will be done:
1090 Midwood Road, Cutcho~ue
tlouse Number Street, Hamlet
County Tax Map No. 1000 S~ction .1.1.0 ....... ' Bl'ock 02 10 /
Subdivision ..................................... Eiled Map No ............... Lot ............ t..
(Name) ·
State existing se and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Single family dwelling
b. Intended use and occupancy Single family dwelling wigh fence:'o: ,,',' , . . ,,"~ ~
3, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...........
R pair R~m al D liti .............
e .............. ov ..... . ........ cmo on .., ............ Swzmmlng pool
y B ildi X
Tennis Court ...... r;~;>c~A¢cessor u ng .......... Fence ....... Other Work; ...........
4 Etim dC 'ff/tD'/~JTtJT'd30. . Fee . ..2.5:.09 ....................... ''
· s ate DSt .............. , .............................
(to be paid on filing this application)
$, If dwelling, number of dwelling units ............... Number of dweilieg units on each floor ...............
Il'garage,. number of cars ...... . ................................................................
6. If business, commercial or mixed :occupancy, specify nature and extent of each type of use ..... , .............
7. Dimensions of existing strucmresi if any: Front.., ............ Rear ............... Depth. ............
Height Number of Stories ..........
Dimensions of same structure with alterations or additions: Front................. Rear.. ............ .
Depth· · . . Height ... Number of Stories .
· ' ' nstniction: Front Rear Depth
8 Dimensions of.~RBrean~w qo .......................................... .
Height . .; ;'. .... '~umber of Stones ....................................................
Depth
9 Size of lot: Front ~ Rear ...........
10 Date of Purchase Name of Former Owner ' ..
11 Zone or use district in which premises are situated ..........
12. Does proposed Construction violate any zoning law, ordinance or regulation: ........................ ~. · ~ · ·
13. Will lot be regraded ............................ Wiil excess fill be removed from premises: . Ye~ ... N~..
' Phone No
14 Name of Owner of premises ' Address ...................
' Phone No
Name of Architect Address ·
~"~ ' Phone No -' '
Name of Contractor : Address . . . ..... a ...........
15.Is this property located within lO0 feet of a tidal wetland? *YES .... NO ....
· If yes, Southold Towni Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all !buildmgs, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
APPRI VED AS'NOTED
FEE: ~SV: ~
NOTI~ BUILDING DEPARTMENT ~
765-1802 9 AM TO 4 P~ 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
THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORK,
COUNTY OF .................
(Name of individual signing contract)
above nerved.
being duly sworn, deposes and says that he is the applicant
lam is the '
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dully authorized to pe~rform or have performed the said work and to make and file this
application; that all statements coniained in this ,'ipplic~tion are ~rue to the best of his knowledge and belief; and that the
work will be performed in the mann!r set forth in the application filed therewith.
Sworn to before me this
/ f da . . . .'. , ?a
......... y . . ~. ....... 19...
Count,
Nota~ Public .................................
~[N~
~ ~1~ ~t~ ignature o f applic~t)
Term ~1~ ~n ~, s~