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Home My WebLink About19060-z ~01t,~ NO. II TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM ~9060 Z Permission is hereby granted to: ..~.~.~.....S.v.~........~...~.....~ .......... .... ~.~.~......~.....~ ................. ...~.~..~, ......~...:~.,.....~:J...~.~.~ .......... ~ ,o '"~""~'""'"":~'~'"~'"'~"'"~"~'~'"'~""~,~.L~ _~ ......... County 'rax Mop No. 1000 Section .....~....~...~ ......... Block ....... .(~ ........ Lot No.....~...'~. ............. pursuant to application dated ...... .~~.~),~...~., ............... ;., 10.~.1:~., and approved by the Building Inspector. Bu~q-dTng Inspector ............. Rev. 6/30/80 FORM NO. '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTIIOLD. N.Y. 11971 TEL.: 765-1802 ^ppro,.ed... ~ ~.,.~ .,,S~..., 19~0. Po=it r~o. :1. 9. .0. .~ ..~ Disapproved afc ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS SURVEY CIIECK ..... NOTIFY~ HA~L Date ..; ........... ,19 . a. Tiffs application must be completely filled in by typewriter erin ink and submitted to the Building Ihxpector, with ' sets of plans, acanmte 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 pubffe streets , or areas, and "' ' '~ of property be draxvn on the diagram which is pzrt of this appli- otvmo a detailed description of lhyo~ must cation. ¢. 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 applieanL Such permit shall be kept on the premises available for inspection throu~_hout the work. e. No building shall be occupied or used in whole or ~n 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, a~ herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inzpcctom on premises and in building for necessary in~ections .. ....... (Mailing address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .&vW~'£c, ............ (as on the tax roll or latest deed) Ir applicant is a corporation, signature of duly.authorized officer. (Name and title of corgorate officer). ~uilder's License ~o .... ~'~'.% ~ ........ Plum her's License No ......................... Electrician's License No ....................... Olher Trade's License No ...................... I. Location of land on which proposed work will be done~ House Number Street, . ~0 ~. ..... , ~,.. .................. · Hamlet .......... COuntyTaxMapNo~lOOOSection . . ~{~c[?''oO ' ............... Block .... ~../, oo 00-) d" ............ Lot... · cD Oo S bdt ............ :~'- · u vision .............................. ~ · l~il '-.' ..... ed Map No. L ' (Name) .............. et ............... · State existing nsc and occupancy of premises and intended nsc and occupancy of proposed construction:' -- b. Intended Use and occupancy ............. . 3. Natura of work (check which applicable): New Building .......... AdditiOn .......... AJlcratlon .......... Rep:fir R~moval Demolition .. ' ' ' ~o~ol. Tennis Court ......... Accessory Building Fence ~ Other Wo~ 4 Estimated Cost · -- Fee ; · (to be paid on filing this application) Ifd N ' 5. welling, nmnber of dwelling units ............... umber o f dwcllmg umts 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 if any: Front Rear ' Depth Hcieht Nun bet o f Stories Dimensions of same structure wgh alterations or additions: Front ........ i.. Rear ..... Depth ...................... Height ...................... Number of]Stones .................... 8. Dimensions of entire new construction: Front .............. Rear ........ =. Depth N fSt Height ............... umber o Dries ............... , ................ 9. Sizeoflot: Front ..................... Rear ................... e ~ .................... 10. Date of Purchase .............. Hame of Former Owner .I ............... Zone or use district in which premises are situated ...... · Does proposed Construction violate any zonin aw, or nonce or regulation: .... i ............................ 13. Will lot be regraded .; ...................... .... Will excess fill be removed from premises: Ye: .... No., 1,.I.Name of Owner of premises ..... · ..' ....Address ' Phone No ' Name'of Architect Address ; Phone No Name of Contractor ................. i ........ Address .............. i ....Phone. No ..... ,¥....,y.;. 15.Is this property located within 100 feet o~ a tidal wetland? ~yE$ .... NO.~..,' '{ mil yes, $outhold Town Trumtees Permit may he required~ PLOT DIAGRAM Locate clearly and distinctly all buHdlngs, 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 whett~er interior or cprner lot. , STATE OF NEW YORK, COUNTY OF ......... $.S above named, AP ROYED AS OTED NOTIFY ~UILDING DEPARTMENT AT 765,1802 9 AM TO 4 PM FOR THE ~OLLOWING INSPECTIO~5, 1. FOUNDATION '~O REQUIRED FOR F OURED CONCRETE 2. ROUGH . FRAMING & PLUMB~MG 3, INSULATION 4. FINAl. CONSTRUCTION MUST BE COMPLETE FOR C~.O ALL CONSTRUCTION ~HALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION CODES, NOT RESPOI DESIGN OR CONSTRUC' & ENERGY ISIBLE FOR 'ION ERRORS being doly ssvorn, deposes and says that lie is the applicant He is the . ' (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to pe,rform or have performed the §aid work and to make and file this application: that all statc~nents contained in this applica, tion are true to the best of Ids knowledge and belief; and that thc Work w~l be perlbm~cd in the m~ner set forth in thc application ~led therewith. : Sworn to before mc this ............ .. .......... dayof ....................... .. Nota~ Public ...... ~.. County . ~&~ ~''~'~''~'~ ..~--~~... . _ ~. 4707878, ~ ~U~/ , -4