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Home My WebLink About18919-zFOU~DAT~ON ~ 1st) FOU:~DATIO:! EOUGH FRAME & .FLUMBING INSULATION FERN. STATE E~;ERGY CODE Fi;:AL ADDITIO~A'L COMME~TS: FORM NO. 0 TOWN 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) N~ 18919 Z Permission is hereby granted t= _ ....~,~.~, - - ~.,~ ,~' /_ / ' /-7 ............ at premises located at .../..~..~..~ ....... ~~.......~..~. .................. · .. ...~.......~w,,~ . ~ ....... , .............................. 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 2.' 0 FORM NO. 1 ? Cji) TOWN or SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .c.~ ....... 19 ..~. Disapproved ale ..................................... /(B ~ffg Insp ''' tu ector) .,iMMEDiATELY,,APPLICAT ON FOR BUILDING PERMIT ENCLOSE POOL TO CODE UPON COMPLETION BEFORE "WATER" INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS SURVEY CHgCK NOTIFY: CALL MAIL · Date ................... 19... a. Tiffs application must be completely filled in by typewriter orin ink and submitted to tile Building Inspector, 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 fityout of property must be drawn on the diagram which is part of this appiJ- 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 untiI a Certificate of Occupancy shall have been granted by the Building Inspector. ' APPI~,I~ATION'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 Count New Y . - Regulations, for the construction of buildinr, s add ~ ....... ~' ,Yo~, and other apph.cable Laws, Ordinances or The applicant agrees to comply with all a;~i'cab~a';;~~ ~r~ireration,s, .o,r,~. or~e ,mov~_~ demolition, as herein described. · . . . _,. .- ;-_~, ~-~mances,.ou .~ c g code, and regulations, and to admit authorized inspectors on urem~ses and m bud ,~,~, ~ '.'~:,. 3- ' , dm= f°r necessa~yS'i~~~ (Mailing address of applicant) State wheth'et)~'ap~0]R~i~nt i~ owner, l~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owh~r:bf p£emi~es . . .. ......... ........ ............... · ' y:~,~, ,~:,, , .... . ,' so or latest deed) If applicant t~ a~)co~'~ratione,~ignatu:re of duly authorized officer. (N~q¢{kn~ifle of ~orporate officer) Plumber's License No ......................... Electrician's License No ............. Other Trade's License No ................... 1. Location of land on which proposed work will be done; HOuse Number Street, .......... · ....... Hamlet '" Co",tyTax,~l..,p No. 1000S,etio, .../.~,~...~. "~Ock ....... d... ~ot Subdivision ......... ~ ...... ~!..~ ............. Eiled Map No. /1~ : (Name) ...... Lot .... State existing use and occupancy of premises and in?nded use and~ccupancy of proposed construction: a. ExiSting use / ~/L ' and occupancy .................. ~.. b. Iht .~-~ fl ........ ' ....~ ..................... ~.. e"~cu Use and ~ ~ ' 3. Nature of work (check which ......applicable): New Building ........... Addmo ' ' '; ~%:i~_ .i~ ' ....... · R:mo~,al ..... Demo ition ..... Swimming pool.; .......... Repair ............. ~ ......... · .... Tennis Court ......... $ccessory Building .......... FeP~ee ...'..0~t]~e~, ~k ............ , .......... .. 4. Estimated Cost .......................................................... (to be paid on filing this application) 5. If dwelling, number of dxvelling dnits ............... Number of dwelling units on each floor ...... ~ .... I£ garage number of cars ............. 6. If business, commercial or mixed occupancy, specify nature· and extent of each type of use ................... Dimensions of existing structurei if any: Front ' " Rear Depth Height Number of Stories ........ Front Rear Dimensions of same smacture with alterations or additions: · · Depth i Height Number of Stories .... ' ' Rear Depth 8. Dimensions of entire newconstr}mUon: Front............ ............................. .. Height Numlber of Stories ' 9. Size of lot: Front ....... Rear ...................... De .............. 10. Date of Purchase i~i~.i~i~'i~iii ............ Same of Former Owner ..... - ........................ 11.. Zone or use district in which pr,~mises arc situated .................... ;;.:..(.~-.fO. ................ "''~'i'' 12. Does proposed construction viollate any zoning law, ordinance or regulation: ......................... 13. Will lot be regraded .; ....... i ................... Will excess fill..be removed, from'premises:. . ~Y~es ..... Ns.. 14. Name of Owner of premmes . .ff~..~. ~.. 6~ .c~. ~.~....~. · Address ff~'~;OT.~...~?..~[.~/z~., · · · Phone .No. '.2'..~..?. Name of Architect ..'-777....i Address .. ... Phone No ................. Name of Contractor ....~Z-.. ~. 'i ........ ~ ........ Address ................... Phone No ..... 15.~s this property localted within lO0 feet of a tidal wetland? ~¥gS .... NO.'~- '~' · If yes, Southold Tow~ Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. OCCIJ?ANC¥ OR USF. iS UNLAWFUL W[[] OLg CF.R'r F CA'i'E OF OCCUPANCY APFROV, ED AS NOTED FEE: ~BY: , NOTIFY BOILDIRG DEPARTI~N'r"'AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSP~:CTIONS: I. FOUNDATION TWO REQUIRED FOR POUR~:,D 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 YQ P~K~ COUNTY OF .:...;~ .~.~... ......... /~. ~, .~... < being duly s~vom, deposes ~d says that he is the applicant · ~ame of individual ~ is the ~ ' (Contractor, agent, corporat~ officer, ~tc.) of said oxvner or owners, ~d is dilly authorized to perform or have perfo~ed the said xvork and to m~e and file this application; that all statements co,rained in this application are true to the best of his knowledge and belief; and that the work will be performed in the m~er set forth in the application filed therewith. Sworn to before me this ; ....... '~ ~a~u~u~ , Ouahf ' Commission Expires July 31, 1