Loading...
HomeMy WebLinkAbout17311-z ~0~ NO. ~ TOW~ O~ $OUTHOL~ BIJILDIHG D~PARTMI:NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 017311 Z County Tax Map No. 1000 Section ~ Block .~...~ Lot No. pursuant to application dated ......... ~.././.. ................................... , 19.~.~., and approved by the 8uiJding Inspector. Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY , ~ ..... 1_0~ CALL ................ / /'-U.:/uO- ~,~. MAIL ~/, Examined · .~/~. .......... , .. Ap ro e .... ......... Disapproved a/c · . ~ ................. :, ~ .*~ ~ m::~'. ,~[ **~f [~ ~PP[ICATIO~ FOB BHILDI~G PERMIT ~ e, ~ ~;,~ INSTRUCTIONS a. T~ a~Matto~ ~ffsg'bo complotely filled in by ~pewfiter or in ink and submittod to the Building Inspector, with 3 sets of pl~;'a~ate pl~f~l~n~t'O~a]~ Fo~ according to schedule. b. Plot pl~ sho~ifig 16aation of lot and of build~gs on premises, relationship to adjoining pr~mises or pubEc streets or areas, and giv~g a~dot~le~ ~e~fi~'fion of layout of property must be drawn on the diagram which is pa~ of this appli- cation, i'. ;,~ ~.~ ~ ~ 5 '~ ,..:, ,~ -,, c. The work c~er~d bY~s ~pplication may not be commenced befor~ issuance of gu~d~ Permit. d. Upon approval o~ this a~plicati6n, the Building Inspector will issued a Build~g Pe~it to the app~cant. Such pe~it shall be kept~on ~he~ises ~vgflable for ~spection throughout the work. e. No bufld~g ~hall' be o~upied or used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy shall have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Building Dep~tment for the issu~ce of a B~lding Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord~ces or Regulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all app~cable laws, ordinances, building code, hous~g code, and regulations, and to admit authorized inspectors on premises and ~ build~g for necessaw inspections. ~.~, ~r. ~. ~o.~ .~ ,.~ ........... (Signatu~f applicant, or ~e, if a corporation) .... ~ailing address of applic~t) Date . .~ ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... .~.tl ....... .~£.h..~/.[. ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. ~..~.,~ b ,./. ~. I. ,~ ~.~. ( 1. Location of land on which proposed work will be done[ ................................................. ....~.~. ........... . ..... .hq..,. (.o.©... ,.~.-~.... : ..... ~g.~ ...... _ ....... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~& ........ Block ...O.~ .......... Lot..~ .~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.©.~.~. ~ .... ~ o.n.~r. . c. onc .~> .~ .~...D .~ .~ ~c~.~. .. ~.o.~.,,~r'~X'.~.~ ................. b. Intended use and occupancy ) . .~. c~.. ¢.~ ~ c'..~ .e.~. O...~.c.~w t ~3 .~-<,_.~ . .~> . .'.~r>~ ~.~. ........... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition. ... ....... Alterat.~_' ........ :[. Repair .............. Removal .............. Demolition ........... i' · · Other Work..~.~, ,.~,..~. .... . (Description) 4. Estimated Cost ....... q2~ ....................... Fee .... ~.~.,.O..(D ................... ·. ' (to bejpaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ............................................ i ............................ 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 ....... i ....... Depth ............... Height ............... Number of Stories ............................ !.,, .......................... Dimensions'of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ...................... Height ...................... Number oX Stories ...................... --8. Dimensions of entire new construction: Front .......... . ..... Rear ........ i ....... Depth ............... Height ............... Number of Stories ............................ i ............................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner 'i ............................ 1 1. Zone or use district in which premises are situated ......................... 1 ............................ 1 2. Does proposed construction violate any zoning law, ordinance or regulation: .... i.l~..,~. ....... ................. 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises....~-..c, w.~ ~ .[.1 ...... Address~2~. Name of Architect .~ ,, ........... Address ............ .~.o./.~Phone No ................ Name of Contractor~a ~. ,~.~. ~,,em...¢ ~.~'~rn~;Address~q-~.~". ~..c~c. ~,t~./~.Phone No..')..~ 15. Is this property located~ithin 30~feet of a tidal wetland? *Y~s .%/... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-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. APPgOVED AS NOTEO DATE~/¢/00'~ 9.P. #~ NOTI[Y ~ILDINO OEPA~T AT ~08-~802 ¢ AM ~ 4 PM FOa THE FOLLOWIN~ INSPECTIONS: 1. ~UNDATION ~0 RffiUIRED FOR POURED CON~R~E 3. 4. FINAL CONS~U~ION MUST (Signature of applicant) .... STATE. CO~TRUCTION..&. ENERGY ................ being duty sworn, depo.;es and says that he is the applicant CODES.(NIgO~ o Rl~li~niff~.8ont rac t ) abovettffaf~tllI. OR CONSI~RUG'q'ION ERROR8 '. He ~s the ............. , ............................................... ~ ................. ~ .r.~l ...... (Contractor,. agent, corporate officer, e~c.~): of smd' owner or owners, and ~s' duly authorized to perform or have performed the s'aid~ work a-t~d to~maae~a~file' ~ this application; that all statements contained in 'this application are true to the best of hislknowledge ar)d behe,~n[lithat-- the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this : ' -~ "' ............. /'. .......... day of..1~/! ....... 19.~.~. Nota. Public, ........... County NOTARY ~Bt~, Sbte No. 4707878, ~u~ Term EXl~res Mar,ch 30,