The URL can be used to link to this page

Home My WebLink About18761-z FOw-'~e NO. '~ TOWN Of: $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 18761 Z County Tax Map No. 1000 Section .............. ~... ..... Block, pursuant to application dated ................. .~../...~,..~ .................. , 19./~.., and approved by the Building Inspector. Fee $.. ~.~..~.~,. ~Buil~nspeCtor Rev. 6/30/80 Examined ............... , 19. Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ..... SURV .Y .......... ' CHZCK . ...... sz T c ................ NOTIFY~ CALL . ~ ......... MAIL TO: 'APPLICATION FOR BUILDING PERMIT ......... INSTRUCTIONS Tkis application must be completely filled in by typewriter or in ink and submitted to the Building I/~spector, 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 er areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation· o. 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 skall 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 B'~filding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or Regulations, for the construction of buildings, ad. ditions or alterations, or for removal or demolition, as in describ _T!le ,.appli,can.t agr. ees to comply wit.h all applicable laws, ordinances, building cx~de, h~usi, fl'g aumi[ autaonzed respecters on premises and in building for necessary in e ..~n~ff~- ' ~.,~.~, ,mu ~o ...... f ,~'P"f"~' ~'v ~ca *, or nal~e,~ a corporauon) ................. ? -¢PL~...;~ .,~. ....... '~ ' (Mailing address of applicant) State wh~ther appl~arfit~*=o .~,.riie. p,, f~s~'d;;~age/?[~'~rehitect engineer, general contractor, electrician, plumber or builder. ..,FOH ............ · ~, ~ ~ ,. ,; .; , (ason the tax roll orlatest (}'~d) I£ applicant is a corporation, signature of duly' authorized officer. (Name and, tRl~,,of ~ol-xte 6fficer).. '", Plumber's License No ' Electrician's License No .................... Other_Trade's License No .................... 1. Location of land on which proposed work will be done; . . tlouse Number Street, Hamlet County Tax Map No 1000 Section " ' BPock et Subdi iSion v . Riled Map No (Name) 2. Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. sng use and occupancy .................... . b. Intended Use and occupancy ~-~e_ ~z~c.~ 0~. Qo ~- o : 3. Nature of work (check which applicable): New Building .......... Addition S Repair ....... Rl~mova! .............. Demohtlon ....1~,~ ~. ,5~ 4. Estimated Cost . ~ ' i ...................... Fee ...... .......... " (to be paid' nmnber of dwelling units Number of dwelling units on each $ If dwelling ............... floor . . If garage,, number of cars ....... i .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................... i 7 Dimensions of existing structures If any: Front Rear .. Depth ............ H,'.ight ............. Number of Stories ..................... · ' " fr;i,t'ill .; Dimensions of same structure withlalterations or addttmns: ...... · Depth I Height . '. Number of Stories .................... 8. Dimensions of entire new constmcBon: Front ...... Height ............... Number of Stories ...... 9. Size of lot: Front ' .. .:. Rear 10. Date of Purchase ...I.~.U. .... ' ....... , .. ..... ........ Rear ............... Depth ........... ,..g ............................ 11. Zone or use district in which premliseS are situated... 12. Does proposed constructionviolat¢ any zoning law, ordinance or regulation: .. .......--......--.''-"'" ' d from rem~ses: Yes .... No.' 13. wm lot be re,,raded ......................... Will excess fill be remove p d e/r-/ ~ .~. .... . o 14. Name of Owner of premises . j .... Address ................... Phone p~o..'~..~.-; ...... Name of Architect ........... ; ............... Address ................... Phone No ................. ' Name of Contractor .......... i ...... ~ ........ Address ............. Phone No ..... Iv' · ' ',Y ...... IS.Is. this property located within lO0 feet of a 'ti~'a'f wetland? *YES .... NO.~.. · If yes, $outhold Town [Trustees Permit may be required. , ' PLOT DIAGRAM Locate clearly and distinctly all t~uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n~mber or description according to deed, and show street names and indicate whether interior or comer lot. AS NOTED FOLLOWING INSPECTIONS: 1, FOUNDATION TWO REQUIRED FOR POURED CONCR~lr:: 2, ROUGH. FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MU~F BE 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 NE~3!,Y_O~,~K, ,/ ~ e -_~,, 4~,o_,,_%, t~3 [ .~.c7~ .,-~..~,)5. Sr...o~.' being duly sworn, deposes and says that he is the applicant · .. (Name of individual stgn!ng c%~tract) above named. He 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 perfommd in the manne~ set forth in the applicatioa qled therewith. ' /: Sworn to before me this , ...... .4 .... day of ........ t/^ at"o-ary Public, ', i