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Home My WebLink About17488-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017488 Z Permission is hereby granted to: ..~.~.....~-~ ...... ...%....~ ...... ~.~ ......... ......i-..~..o....~....~.~..~ ............................................ ' I .~.~...~~ ........... L.~..~ ........ . ,o ...c~l.~....~.~...~.~.u~......~.....~.~t~.. ............................. County Tax Map No. 1000 Section ...... .~...-~.....-J ...... Block ...... ..C~....! ......... Lot No .........C)....l ........... pursuant to application dated ......~..~ ....... ..c~..,~ .......... , 19.~.~.., and approved by the Building Inspector. Fee $...~ ................... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined · .~....~...~...., 19 .~.~. Approved .O. · .~.~':L~....~ .... 19 g.~. Permit No.}. .~..~..~..~..~ ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: , TOWN OF SOUTHOLD i a. Tins application must be completely filled in by Wpewriter 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 l~yout 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 the premises available for inspection throughout the work. 8. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shill have been granted by the Building Inspector· APPLICATION IS HEREBY M,~:I~t~t~'}J~ding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of tigefTo~n iqf}~q~hi~El~lSuffolk County, New York, and other applicable Laws, Ordinances or Regulations for the construchda :Q~i~uildln,gg~,i~f~d}~igC~s or alterations, or for/'emoval or demolition as herein described· The applicant agrees to coml~ly;~v]~l~ lfl:,a~l~l{¢iiblb~lhWs, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on ~(r~4~f~ ~b~ling for necessary inspections. . (Sfgnature ot applicant, or name, if a corporation) .... (Mailin~ address of aii/plicant) State whether applicant is owner, lessee, agent, architect, en~neer, generJl c0ntra~c~or, electrician, plumber or builder. ,, ..... Name of owner of premises ...................................... ~t (as on the tax rqlt;:gr.la~d, eed) If applicant is a corporation, signature of duly authorized officer. .¥~ ~2~ .C~. ... : .......... ~11~ ~vl(.~.~ (Name and title of corporate officer) ~}~O t~ Builder's License No .... I P.?. .~. .'~:~. . · ~.~T_2 ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ............................ O. &l<. . .................................. House Num her ~ Street Hamlet / County Tax Map No. 1000 Section .............. Block .................. Lot / .~.~..~S'.~ ....... Filed Map No ............... Lot ............... Subdivision... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................ ~ ........................ ~ ........ ~. ....... 3. Nature of work (check which applicable): New Building ' Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... /~ (Description) 4 Estimate'd Cost ~] ~ ' Fee (to be paid on filing this application) 5. If dwelling, number of dwellin~ 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. Dh] !n~iona of existing structures, if any: Front ............... Rear .............. Depth ............ Hel ltl 4 ~ ". ' ' Ndmber of Stories . . ' ' ' n. slons of same structure with alterations or additions: Front ............ i... i l~ear ............. De flOlq U ~i tl:l~ ....... Height ..... Number of Stories ............. 8. Did n~ions o~n~ii~ n~'cons ruction: Front ............ Rear ............... Depth .., Nmnber of Stories ........... Hei ~k ~ 9 Siz{ of loi4 F~ront Rear Depth 10 Dat~ of"Pfi~:chase · Name of Former Owner 1 1. Zone or use district in which Premises are situated ..................................................... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: ..t:/..rq. ........................... 13. Will lot be regraded ........ ~ .................... Will exc_es~ fill be r~move.d, from premises: Yes No Name of Architect ......... ! ................. Address ................... Phone No ................ 15.18 this property lochted within 300 feet of a tidal wetland? *¥E$ .... NO.~.. *If yes, Southold Tow~ Trustees Permit may be required. .. i PLOT DIAGRAM Locate clearly and disthactly ali buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and blocl interior or coruer lot. : number or description according to deed, and show street names and indicate ~'hether , o2 FOR THE FOL[ OWING INSPECTIONS, 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION i 4. FINAL CONSTRUCTION MU~T 8E COMPLETE FOR C.O, ALL CONSTRUC~ON~ ME~ THE REQUIREMENI'~ OF THE N.Y. STATE CONSTRUCTION & &NERGY CODES, NOT IJEFONII~U! FOR DESIGN OR CONSTRUCI~ IRROR~ OCCU NCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NF~"~ORK, w j .... C_~. (Name of individual sigqi~g ~-6ntract) ~.... being duly sworn, deposes ~d says that he is the applicant above named. ~ els the ..................... 4..~ .... ~ .................... ~ ............................ ./~(Contra~ent, corporate officer, etc.) of said owner or owners, ~d is dul~ autho~d ~o perform or have perfo~ed the said work and to m~e and file this application; that all statements cont¢ined ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this : ~::;2~:'t3 ~ - ' ~~ .... ~~ (Signature ofapplic~t) [ No, 62-812~, Suffolk Count_