The URL can be used to link to this page

Home My WebLink About17411-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017411 Z Permission is hereby granted to: .~ / · ~...~.....~..-~....~ ........ ~_~.~...~.~~-~.~/~.....~/ .... ~~...~~,..~.~.: ....... ~./.~~ · / ~ , o,,re~,,e,,~,.~, ......... Z~ ................... ~~......~ .................................... co~,~ V~x Mo~ No. ~000 S~t~on ......... Z~..~.. ~ .......... ~. ...... ~o~ No ...... ~.,.Z ..... pursuont to opplicetion doted .......................................... ~. , 19~, end opprov~ by the Building Inspector. ~ev. 6/30/80 ~ ~O~ TOWN OF SOUTHOLD , ~/ ~ 500 t ~)..~-.c~SOUTHOLD, NEW YORK / ~' ~Owner's Agent or Person Performing Work) (Address of aSov~a~ed person) YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: ~ ' (Address'where work is to be Dropped) TAX MAP NUMBER .../DO O- [oD-g- ~o, { ~rsuant to section [~0 ~ [~( of the Code of th~ Town of Southold, New York you am notified to immediately s~pend all work ~d bulling acti~ties ~til this order h~ been mseinded. BASIS OF STOP WORK ORDER: CONDITIONS UNDER WHICH WORK MAY BE RESUMED: Failure to remedy the c6nditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. DATED: BUILDING INSPECTOR / CODE E~FORCEMENT OFFICER Disapproved a/c ............................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL EOUTHOLD, N.Y, 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEPTIC )0RIq ............ NOTIFY -- CALL ..................... MAIL TO: ' /(~uild(ng In~pe~o~/ ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .................. , 19... a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Buildifig 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, r~lationship to adjoining premises or public street~ -or areas, and=lyre,,,,' ' ,, a detailed description of l~tyout of property must be drawn on the diagram which is part of tiffs appl~- ~'cation. c. 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 building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc3 shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmen't 'for the' issuance of a Building Permit pu'~'ant to thc Building Zone Ordinance of the Town of Southold, Suffolk County;-New York, and. other applicable Laws, Ordinances or Regulations, for tl~l~l~ll~l~l~Aildings, a,,d, ditions oF alte3ations, .or f6r removal,Or demolition, ts tierein described. The applicant agrees to~q~iply with ~I1 al~able laws, ordinances, building code, housing code, and regulations, and to admit auth,,,b.~,~ a,;~&A~i~/~fl'~i5 .'t~i~'~'n"building for necessary inspe§tyon~. . ........ ~[lllll~ ~ ffi):t (Mailing address of applicant) · ~ ~ ~. xt~ .~ State wl~ether applicant is own~~egt, architect, engineer, general contractor, electrician, plumber or builder. "97'> , ,'" ::. .... ~~ , ~, (as on the tax roll or latest deed) If applicant , 0~.~thorized officer. (Name a~d titie of c~rporate officer) Builder's License No ....... . .(-2'ff~..Q'T<...~.~....' ..... Plumber's License No ......................... E ectncian s License No ....................... .... County Tax Map No. lO00 Sectim~ .: ~4 (.V~ ...... ~ ......... Lot...4~,. J ......... (Name) ...... 2. State existing use and occupancy of premises and intended use and occupancy of ~roposed cons/ruction: a Existing use and · occupancy ..................................................................... b I d . ntende use and occupancy .......................................... 3. Nature ofxvork (check ~vhic applicable): New Building .......... Addition .......... Alterat on .. ../... Repair .............. R4moval ....... Demolition ....... Other Work (to be paid on filing this applisation) 5. If dwelling, number of dwelli~ng traits ............... Number of dwelling units on each floor ............... If garage, number of cars .. ~ .................. 6. lfbusiness, commercial or miNed occupancy soecif 0.7 ::: ::: ~. ~ , ~ y ture xte leach type of use'. .... Height ............... NBmber of Sto~es ..... .. ~ : . R .............. Depth 2... ~. Dimensions of same structural with alterations or additions: Front Depth ~ I Img ~t .................................. . ,. Rear .................. ; ............ Number of StoNes , Dlllle~Slo~s of entire new construction: Front Rear ' ' ' .............................. Depth .............. Ileight N~mber 6f Stories Size of lot: Front .................. Rear 2 Depth Date of Purchase I .................... Z ...... ' ......... amc of Foyer Owner ................... one or use d:stnct ~n wluch premises are situated ............... ; .... . ................................ Does proposed construction v o ate any zonin aw, ordinance or regu ation ................................ NW~l°t ~;regraded ', ...... ~ .................... Will excess fill be removed from premises: Yes e o wner of premises .................... Address ................... Phone No ..... ' .......... Nme of Architect ........ ~ ......... N f C , · ......... Address ................... Phone No. me o ontractor ....... ~ .......... Add ' Ph · ,, ' · ....... ress ................... one No ............... 15.I$ this property lo¢ated within 300 feet of a tidal wetland? ~YES .... NO...; ~If yes, Southold Town Trustees Permit may be required. PLOT DIAG~ Locate cle~ly ~d distMctly ~1 buildMgs, Nether existing or proposed, =d, indicate ~1 set-back d~ensions fro~ W prope~y ~nes. Give street ~d bloc]k number or description accordMg t~ deed, and show street nines and indicate whethe, interior or corner lot.. 10, 11. "12. 13. 14. STATE OF NEW YORK, COUNTY OF .... . ........ , S,S a ne ofJ ldxv du. agnmg contract) abOve nanled. ~ FOUND4flON . 4. FINAl. - ~-~ OESlGN Ol~ ' being duly sworn, deposes and says that he is the applicant ite is the ' (Contractor agent corporate officer ere) ............ of said owner or owners, and is du!y author zed to perform 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 perfo~ed in the m~n~r set forth in the application filed therewith. Sworn to before me this ................... ' y of .......... , 19 ' Nota~ Public ............. County . ~ PUBLIC, ~ o~ ~g y~ (Signature of appIic~t)