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Home My WebLink About17746-z FORM NO. ~ TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIUGIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ ' Ul/~ Z Permission is hereby granted to: ~ ............................. ': .................. ~ .......... ~'"';Z'~'}'"'FS .............. ~'="'~']')J' ................. pt premises located at ..~.~ ...... ,~.~.~~...~ ........ /.X.~.,~~ ................. County Tax~ Mop No. 1000 Section ........ ~../..~.. ........ Block ....... ,/./. ........... Lot No......c~....O.. ............. pursuant to application dated .... ...~.~~....~.. ................ , 19~..~..., and approved by the Building Inspector, Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Exanfined., .~.....~. ~o.., 19x~.~ Approved .~~..~0., 19~..~. Permit No. ).'9.~ .~.~. ·~. Disapproved a]c ..................................... (Building Inspector) ~PP[IC~TIO~ FOB BOILDI~G BOARD OF HEALTH 3 SETS OF PLANS SURVEY .......... CIIECK .......... gEPTIC FORM ............. : CALL .... tT0: Date ................... 19... INSTRUCTIONS , a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 this appli- 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 thee 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 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, as herein described. 'the applicant agrees to comply with all applicable laws, ordinances, building .~ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti~ ~ ~.J 7~ ~ ........... ./c,g4q , · .......... (Signature~ applicant, or name, ~t a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ph4mber or builder. Name of owner of premises .. fi ff.//.~. ~..~.. t~0...,~JJ3/.,~. .... ~.~.]].[~..~.,$'...~d_._.~.~_~.~.ff~. ......... (as on the tax roll or latest de~P~t, ,.~. DATE' IIb/~q a.p#/~?~...~_~'~ II'applicant is a corporation, signature of duly authorized omcer. ' ~ ' ' ' ,/ ~ , FEE: Y. L. NOTIFY BtJILDING DEPARTMENT AT (Name and title of corporate officer) · 765~1802 9 AM TO 4 PM FOR THE ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED FOLLOWING INSPECTIONS. Builder's License No .......................... 1, FOUNDATION TWO REQUIRED ~ FOR POURED CONCRETE Plumber's License No ......................... 2. ROUGH - FRAMING & PLUMBING 3. INSULATION : 4, FINAL CONSTRUCTION MUST Electrician's License No ....................... BE COMPLETE FOR C.O. OIher Trade's License No ...................... 'ALL CONSTRUCTION b:4ALL- MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY I. Location of land on which proposed work will be done ................. COOES.' 'NOI' 'RES~ONSIB£E ' 'FOR ' ' ' ..................... . .... ........ $ ...... ltouse Number Street Hantlet · ]J ~.. 11 Lot..~.' ~ ...... County Tax Map No. 1000 Section .... ,. ......... Block ..,1 .............. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing nse and occupancy of premises and intended nse and occupancy of proposed construction: fg)e. ' ............ a. Existing use and occupancy ................ teVY'./~.- ~r. .............. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ' . Addition .......... Alteration ...... . .~ · Repair Removal ' Demolition Other Work ~.~..~.~.'.J~ ._g~.d d' (Descrlpllou) 4. Estimated Cost ..................................... Fee .................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ........ Number of dwelling units 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 Height ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front Rear Depth ...................... Height ...................... Number of Stories ................... · 8. Dimensions of entire new construction: Front ' Rear Depth tleight ............... Number of Stories ...................................................... 9. Size of lot: Front ...................... Rear ...................... Depth .................... 10. Date of Purchase ............................. Name of Former Owner ........................... 1 I. 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 ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No...,~ ........... Name of Contractor ....................... Address .... ; .............. Phone No ............... 15. Is this property located within 300 feet of a tidal wetland? ~Yes ..... No ...b~.. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-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. STATE OF NEW YORK, COUNTY OF S.S 5 ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above nauled. lle is the ........................ ' ................................................................. (Contractor, agent, corporate officer, etc.) of said ow,mr or owners, and is duly authorized to perform or have perfonned 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 performed in the manner set forth in the application filed therewith. Sworn to before me this ...................... day of ............... ,, 9 Notary Public ....... ~ ...........Count ~IEL£N K. l)E VOE - NOTARY PUBLIC, State of flew York ..... · .......... . No, 4707878 SuffolkCounty~.0 / ,/' . ' (Sigflatflrc ofapplican lerrn Exp r~s March 30, 19