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Home My WebLink About17667-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERJ~IT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NR bi7667 Z Permission is hereby granted~fo. ~.~ ..~....~. ~,~ ~,... ~... ..................................................................... premises ,~,ed at ~/.~.....~~...~[' .... '"~... -~'~ .~.~...,......~ ...................................................... ..~ ........................................... ....... .................................................................... Coun~ Tox ~p ~o 1000 S~ct~on . ~ .... ~l~k ....~.~ ........ Lot ~o . ~.~.~... pu~u~nt to ~pphc~t,on do~d ..I.~~... ~ ~ 19~., ond ~pprov~ by the Building Inspector, Fee $ ,..~,,.~..-,,.,,..,'~.~,,. B'~uilding Inspector Rev 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL.. 765-1802 ,19 l .g. Pc=it No.. BOARD OF HEALTH .......... 3 SETS OF PLANS ~ SURVEY ......... ~ ......... C~ECK ...... -Ct..K .~ ...... SEPTIC FORM .............. eOT~PY ~77'Y~75 CALL ........... MAIL TO:~, ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ./.~- /-~. ....... 19~ INSTRUCTIONS a. Tkis application must be completely filled in by typewriter orln ink and submitted to the Bmldmg Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showmg location of lot and of braidings on premmes, relatmnshlp to adjoining premises or pubEc sir. or areas, and gzvmg a detmled descnptmn of layout of prope~y must be drawn on the dzagram whzch zs paff of t~s ap Ca,on. ~. The work covered by t~s apphcat~on may not be commenced before ~ssu~ce of Building Pe~L d Upon approval of fl~m apphcnUon, the Bmldmg Inspector will ~ssued a Bmldmg Pe~ to lhe apphc~L Such pex shalI be kept on tt~e premises avaflabte for inspection throu~ou/the work. e. No bufld~g shall be occupmd or used ~n whole or ~n part for any purpose whatever unhl a Ce~cate of Occupm shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Dep~men/for the msuance of a Bmld~ng Pe~it pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable ~vs, Ordinate- Regulations, for the const~c/~on of buildings, add,hens or alterauons, or for removal or demohnon, as hereto descnb The apphcant agr?~to cpmply w~th all apphcab~e laws, ordinances, building code, housing code, and regulanons, and m bmldmg for nec~ssa~ m~pec~on~ _ .- (Signature o~ apphcant, or nam~[ a ~rpofa~ion) (Maihn~ address of apphc~t) t ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build · ............................................................... (as on the tax roil or latest deed) If apphcant m a corporata~n, signature pfduly authorized officer. - //~' (Name and title of corpdr~te officer) Builder's License No 6/.~...~.. ............. Plumber's License No ....................... Electrician's License No .................... Other Trade's License No ................ I. Location of land on which proposed work wdl be done ............................. ............... m , . ............. House Number ' Streetx ' Hamlet County Tax Map No I000 Secuon ............... Bt~ck ~ Lot... .......... Filed Map No .. Subd~vmmn ....... (Nani~) ~, . ............ Lot. State exlstmg use and occupaflcy of premises and ~ntended use and occupancy of proposed construchon a Ex~stmg use and occupancy .. .~t~ '.~- b. Intended use and occupancy ..... ~ ........................ 3. Nature of work (check v, htch applicable). New Building ......... Addition ......... A/teratlon~ ........ Repmr .............. Removal ............. Demolition ............ Other ~r~ ~.~¢'.~_..... ~licnpBon) (to be paid on filing thru apphcatmn) N b fd I1 h fl 5. Ifdwelhng, numberofdwelhngunits ........... um ero we mgumtsoneac oor ............. If garage, number of cars .... ~ ........................................................... 6 If business, commercial or m~xed occupancy, specify rkaSure and extent of each type of use . A~.~ .......... 7. Dtmenmons of ex,sting structures, if any Front... [Y./~ ....... Rear ............. Depth ............ Height /.~./. ......... Number of Stones ..... /.Y.~7:. Dlmenmonsofsamestrncturew~thaltcratmnsoraddmons Fr;~'.iiill iiiii'iiii Depth ...................... Ilmght ................. Number of Stones ..................... 8. Dimensions of entire new construction Front ............. Rear ............. Depth .............. Height ............... Number of Stones 9. Sizeoflot Front .... ~.: .............. Rear ..................... D~e~.th .. .................... I0. Date o£ Purchase ./}'..$; ...................... Name of Former Owner .]'v.~,,4 ..................... 11. Zone or use district in which premises are situated ....................................... 12. Does proposed construction vmlate any zomng law, ordinance or regulatmn..3/~ ................... i iii~ 13 Wdl lot be regraded . ~d~.. . ._.M~;&r~..._.;_.... .... Will excess fill be removed~,PhonefrOm premises. Yes 14 Name of Owner ofpremlses&-l~-C~2 ~ea~v~"'.. Address ~(~.Ct*~lq. No. Name of Architect .......................... Address ................... Phone No .............. Name of Contractor .......................... Address ................... Phone No 15.1s this property located withln300 feet of a tidal wetlautd? *¥E$'.'.'i~'O'~'.:' *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly nll bu~dmgs, whether ex~stmg or proposed, and. mdmate ~11 set-back dmaensmns fro~ property hncs. G~ve street and block number or descnption according to deed, and show street names and red,cate wheth, interior or corner lot. 14 o a~ :-'-~-- - 1 APPROVED AS NOTED DATE: NOTI~- BUILDING OEPARTMEN '/65-1802 9 AM TO ~ PM FOR THE FOLLOWING INSPECTIONS 1. FouNDATION TWO REQUIRED pO~313RED CONCRETE 2ROUGH - FRAMING & PLUMBING 4. FINAL CONSTRUCTION MUST 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 NEW YORK, S S COUNTY OF ............. (Name of individual mgnmg contract) above named ·. being duly sworn, deposes and says that he is the applica~ Ite ~s the ........................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Is duly authorized to perform or bare performed the said work and to make and file th apphcatmn, that all statements contained m this application are true to the best oflus knowledge and belief; and that tt Work wdl be performed m the manner set forth in the application filed therewith Sworn to before me ttus ....... :.. ....... day or ..... .......... Notary Public, HELEN Y~ DE VOE NOTARY PUBLIC, State,~ New Yeck Term ~res M~ch ~, ~9 ~ z