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Home My WebLink About18968-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 18968 Z Permission is hereby granted to: ...... ................ ~...~.~.~. ................................. ·~~..~.~.. 4/~f.~'~' ,o ' -"-" ............ 7"'"V- ..................... 77'"'-'~""'"~'''''' .............. ~t prem ses ocated at..../....~..{ .~ , .Clb .... ~; ......................................... County Tax Map No. 1000 Section ....... ./../.....~....... Block ..... ../..'..~.... ....... Lot No..../.....'~... ............ pursuant to application dated .................. ~ .............................. , 19. and approved by the Building Inspector. Fee $..~..~..~ Rev. 6130/80 LO~' $ I pu~ ~uo~ ~P ~Tq~ ~q pe~aod~uT ,,, 1'own O;SOUmOLD FORf'~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CttECK ...................... SEPTIC FORH ................ NOTIFY~ CALL .......................... (Buil~ffng In~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ......... a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the 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 layout of property must be drawn on the diagram which ispart of th. is applL cation. ¢. The work covered by tiffs 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 build~ng 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 Southold, Suffolk County, Nexv York, and other applicable Las~, Ordinances or Regulatio~us, for the construction of buildings, additions or alterations, or for ~: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 authorized inspectors ~n pr~mises and in building for necessa~~ ~* ; ........ , - (Signature ot applicant, or name, Mailingadd~-essofappiicant ' ' ' appucant is ;owner, lessee, agent, a~chitect, engineer, general contractor, electrician, plumber or builder. A .............. Name of oxvner of premises , '(as on t'h'e'tax roll o~ latest deed') If applicant is a co~qration, signatu.re'of duly, authorized officer. (N ~.a~l,~ ?~o~p cfi ) .... amc o . orate o ccr PI~mber's License No. . ,.~.//~.. Elcctrician's License No ..... .~./~.. Other Tradc's License No ..... /~../~. .......... I. Location of land on which proposed work will be done: tlouse Number Street .......................... ' Hamlet ....... County ma,, ,~ap ~oi 1000 S,c,io~ ................ ' mock ..... !3[... Lot /..~. '" SUbd ,s on ............... ~_. tc'-~,~E .... .' ' · ................................. Eiled Map No. (Name) ............ Lot .......... · State existing nsc and occupancy of prcm, iscs and intended usc and occupancy of proposed constrnction:- , -- occupancy.. - .................. ~ ................ ~.~.~%~ _,~ ............. b. Intended Use and occupancy ................... : ..... ~:s~.¢ ~. m~ ~ '~',M -~' ~ '~ ,~.~ ~1 '~j~l ....... 3. Nature of xvork (check which app!icable): New Building .......... Addition . .~. ..... ,.. e · -.~ .;~;-. ..... Tennis Court ......... Accessory Building .......... Fence .. ~....O~her: , (to b~ paid on filing this avplication) If business, eommercml or m~xed occupancy specify nature and extent of each type of uso ., ,~/~ ........... 7. Dimensions of existing structures; iC any: Front .... ~1.. 1~ ..... R~r .... ~.. ff ....... Depth .~ Hm~l t .............. Numb~r of Stones .... ff ................... . ................. ~ ~ ........... Dimensions of same structure wit~ alterations or additions: Front ..... ~ ........ Rear .~ ........ ' ..... Depth ......... ~[~ ........ . HeiSt ...... ~ ............ Number of Stories...~/~. .............. 8. Dnnensmnsofentl~enewconstm~tmn:Front .... ~/~-. . Rear .~ ... Depth ...~ ' ' ' ................. Hmght ..... ~/~ ...... Number of Stories ....... ; .................... L ......... 9. Ssze of lot: Front .. ~ ' .. ~ q~,~ ~4 ~,// ' ,, , .. 11. Zone or use dmtrict in which premises are situated. ~.~.~.t~'~...~y~ ~Q ..~'.. 12. Does proposed construction violate any zoning law, ordinanc~ or regulation: ... ~ ....................... 13. Will lot be regraded ·; ...... ~.~ ........ Will excess fill be removed from premises: . Yes .... 14. N~e of Owner of premises . ~. ~. Address .~$PJ f~X .~¢~... Phone No. g~:~.~? ..... N~c'of Architect ........ ~/~. ......... Address ................... Phone No ................. N~e of Contractor ...... .~,,,.: .......} '. ~ ~. Address ................... Phone No ..... ,v...:/~ .... I5.Is this property locat~ed within I 00 feet of a tidal wetland? mYES .... NO.v... · If yes, Southold Town;Truntees Permit may be required. PLOT DIAG~M Locate cle~ly ~d dist~ctly ~1 bufld~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from propemy Hnes. Give street ~d block number or deschption accord~g to deed, ~d show street nines and ~dicate whether interior or corner lot. APBROV AS NOTED _ DATE: ~B.E # FEE: ~BY: ~ ~/ N~IFY BUI~ING DE~T AT 765-1802 9 AM ~ 4 PM FOR ~E FOLLOWING INSPECTIONS: 1. FOUNDATION ~0 REQUIRED FOR POURED CONCR~E 2. ROIJGH * FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONSTRUCTION MU~T BE COMPLETE FOR C.O. ' ALL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N.~ STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUC~ON ERRORS STATE OF NE~V Y~RI-)~.~ ~/ , ~. o cou, T¥ -Sff ............................... . ................... being dnly sworn, deposes and says that he is the applicant . (Name of individual signifig contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly~ authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statmnents contai'ned in this application are true to the best of his knowledge and belief; and that the Work will be perforator in the m~ner~set forth in the application filed therewith. . z Sworn to before me this .'5