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Home My WebLink About17288-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT El'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017288 Z Permission is hereby granted to: ,/~ ~./ / ~ ........ Coun~ ~0x Map NO. 1000 Section ........... .~.~., Bilk ............... ~.. Lot NO ............ ~ ........ pursuant to application dat~ .............. Z~.~ ................... , J~, ond approv~ by the Building Inspector. Fee $.. ~.~..~.~ Rev. 6/30/80 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or cc ~, ,uL. ~,~ /~,-~ ' ...... ~-] FORM NO. 1 TOWN OF SOUTHOLO RUILDING DEPARTM F-NT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTIt ...... SURVEY .-~., ........ ' cHEc 119Y . . .' i SEPTIC FORH ................ ........... ennit No . . Disapproved a/c ..................................... (Buildin~fispector) APPLIgATION FOB BUILDING PERMIT NOTIFY CALL ................ tAiL ' · Date ................... 19... INSTRUCTIONS a. Tiffs application must be c~mpletely 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. ¢. The work covered by this application may not be commenced before issuance of Buildlng Permit. d. Upon approval.of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on tile 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. T!,e .applican.t agr. ees to ~i~ql~hr~i~,~'~ll~t,l~g~lical~'re laws, ordinances, building code, housing code, and regulations, and to aum,t authorized mspect~r~ly~rffi~i-~'nd ~:b~i:~d~g for necessary inspections. ' ~f~T'~,~.~'~·i~'~ ~' g:! ;::" . (S~gr~i~tttre ot applicant, or name, if'a co}t~o'r~;u~n')' ' ' State whether applicant . ~l~g~:;,r~ g ~}~{~.~.~a~,~-~. ...... engineer, general contractor, electrician, plumber or builder· ?: A ......................................... Name of owner of premises .',* ).'.?;'; ;},.*..., ~..;~Cx'~l..~.~ ONt v ~ ;~'~ ;~r:. ~t~-~:~,'~- ~F*::*: :~':; (as on the tax roll or latest deed) If applicant is a corp:~, gigv~m~ro~oPdul~:iuth'6rized officer. (Name afid~ikle';~'co~orate officer) Builder's License No....T~.,~. ~. ~F~..~... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ' Location ofland on which proposed work will be done. '/'~:~':~i<CO.~ }louse Number ............................................................. ' Streeq Hamlet ' ' County %x Map No. I000 Section ~ ~; " .............. Block ........ Lot Subdivision ~ .1.5. x ....... (Name) ~. · ..... = ....... Lot State cresting use and occupancy of premises and intended use and occupancy of proposed construction: ..... ~ ~ ........... ~ ................. b. Intended Use and occupancy ................ ] ............ ~¥ . c. ,;, ,,~< ~, ~, N 4 . 3. ~ ature et Work (check v,'inch applicable): New Building . . '. Repa/r .............. R, emoval .............. Demolition" Addition ..........Alterati,..qn., ...... i ............. Other Work. 4. Estimat 'd Co,, ....... .5..¢. $. ~f dv, elimg, number of dwelllng units ....... (to be paid on filing this application) 6. lfgarage, number of cars .. !'. ......... j ....... Number of dwelling units on each floor .... ' If business. COmmercial or mlxed occupancy, spccif,,na;,: .... ,'' -' - '', ................. J ......... ,7. Dimensions of existing st, n ctlures ifa " , y ,ri: anu extent el eaCh type of use .... ... ' ~ ..... : · ny trent, · ~ezgJlt,.-r~,-,~. d ~, :' %'~(;',~,, ...... ' .............. Rear ~, -. ' ..... -,4,- .'.,,t.*',:t ~ _ ',x .-?~.., ,,.t.',oumver et :Sion ~ .............. ~eptll ...... a.J~pH1 . · · · *'~!} vv --~ .a, ~auOl[Ions: t'ront ,, ....... ,'-; ' . ;da*.' ld~.' * · ili~ .... llel~ht .............. ltcar ...... S. ~{l.n,,ens,~ll~llti~ll~w ,e0stmction.?Sront .................. Number &Stories ....... j jjjj ...... .~ , = t ..... ... ;iNn llbe.' ~.c o .......... Rear .... Der, th 9. s~z~:2fJat:~.:F;ror~ ,.,., ...... : ..... · ................... . ..................... 10. Date of~gr¢ltas8 '~.* ,, :5 . i ....... ~tqear .............. nth ......... · ' · ....... c~ame el t'ormer Owner ....... 1 I. Zone, or'Use district in wh:~'- - · 12. --- :~remmes are situated . .... Does proposed construct;,-- ·,.~_. · · ................. ' ' · 13. ' ,~-v~ulalcan Zen' ' ...................... Will lot be reoraded : Y lng law, ordinance or re-ulation. · ...... Name ofOwnerorpremises .:j"j' .' · "· ' "ie'sl ..... y.~ · ' ......... Wdl excess fill be removed from premi 14. Name of Architect ............ Address ............ m .... ~,, ' ~'"' .... ~";' Name of Contractor ..... ,.. i. · ' ' .............. Address ................... Phone No ............... ................. Address ................... Phone No. 15.Is this property loeiated within..,]00 feet of a tidal wetland? :~YES .... NO .... · If yes, Southold To~n Trustees Permit may be required. -. i PLOT DIAGRAM Locate c/early and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror:.- property lines. Give Street and block number or description according to deed, and show street names and indicate whether interior or comer lot. i 4, FINAL CONgTR~N MUST BE COMPL~E FOR C.O. ALL CONB~UC~ON ~ALL ME~ THE REQUIR~E~ ~ ~ N.Y, STATE CONBTRU~N ~ ~ERGY CODES, N~ REB~81B~ ~R D;SIGN OR C~S~U~N ERROR~ STATE OF NEW YORK, ~ TOUNTY OF $.S (Name of nd.v~dual sign 1:: contract) ~bovc named. being duly sworn, deposes and says that he is the applicant lc it the ............... (Contractor, ag .nt, corp ;;'' ;' ' ' .......................... ~ ate ffi c,e . .- f said o~vner or owners, and is dud 2uthorlzed to perform or have performed the said Work and to make and file this :~plication: that all statements contailicd in this application are true to the best ofliis knowledge and belief; and that the ork will be performed in the manner slet forth in the application filed therewith. .yom to before me this I ........... da,, or i, · .... , °~arT Public ..... ~' · ~"' 'i~''' .~. .~. · County (Signature of'applicant)