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Home My WebLink About17514-z FO~M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 517514 Z ...~......~..>.....~:.....:...~ ...... :': ...... :: ...... :..: ....................... =================================================================================== County Tax Map No. 1000 Section ......... .~.~... Block ............. Z ..... Lot No .......... ./....~.. ..... ~urs,o,t to opp"cation dote~ ..... /.~.:~ ................................... , 19~.~.., on~ opprov~ ~ t~e Building Inspector. Rev. 6/30/80 SURV£y FOR £REY 8~ WIG,HI-MA A T P£CONIC TOWN OF $OUTHoLD SUFFOLK COUNTy N. y >~' '~ ~ ' '~ BOARD OF HEALTH ...... ~e' b:~?..: 3 SETS OF ANS ....... ,?~<l~ I~;~,'~' ~: ~",~ ,',,, ~'~" ,~'*'~''FOR~ NO. I SURVEY .......... ~ ,?~?.:~: . < c~ TOWN OF SOUTHOLD CHECK · · ~-~- BUILDING DEPARTMENT SEPTIC ~0R~ ............. : 7 TOWN HALL TEL.: 765-1802 Disapproved a/c ..................................... ................................. ....... ........ INSTRUCTIONS a. T~s sppUcation must be completeJy Q]led ~ by ~pewriter or in ink and submitted to the Building Inspector, with 3 s~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~g location of lot and of build,ga on premises, relationship ¢o adjoining premises or public streets or areas, ~nd giv~g g det~led description of layout of property must be drawn on the diagram which is pa~ of this cgtion. c. The work covered by t~s application may not be commenced before issuance of Bulldog Permit. d. Upon ~pprowl of this ~pplic~tion, th~ Building Inspector will issued ~ Build~g P~it to the ~ppHc~nt. Such pe~it shah be kept on the premises available for inspection ~roughout the work. ~. No building shah be occupied or nsed Jn whole or in p~t for any purpos~ whatever until~ shall have been granted by the Building Inspector. ~,' ~ ~a~:-':,.()~8l~ ~ APPLICATION IS HEREBY ~ADE to th~ Building Deponent for the ~ss~nq~?~p~ r~,~?n~ ~o me Building Zone Ordznance' of the Town of Southold, Suffolk County New Yor~ a~q~¢~P~b~:~s. ...... ; . , , 'Ord~ces~,~t.~. ..... or Regulations, for the construction of build~gs, additions or alterations, or for re~o~al;oL~4em~lt~o~a-~s here~n described. The applicant agrees to comply with all apphcable laws, ordinances, bufld~g.co~e~';hot~nk~d~{[~&[~9[~s, and to admit author/zed inspectors on premises ~d ~ build~g for necessa~ inspectio~.i~*~fa ~)~ ~,, ~ ..... ,, -. ....,.,. ....... S. ~t~ ~t~e~ ~'t. . 1'~~ ~s~wner~lessee .......... agent_ ~chitect,. ..................... engineer,, general----' '"'''~- - p~,,, .,~__,.,,, ~ _., ~ ,.' contr~,~,le~rician . ..... plumber ~ or ....... builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized 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 ...................... ,~. (~,_ 1. Location of land on which proposed work will be done...'.~f.~ .~..~..~.. .... .?~.'- .~,( .fi~. ~~. · .~.~. House Number Street Hamlet County Tax Map No. lO00 Section ... 1~./7...~.. ..... Block ...~)..t ........... 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 .......... .*~., .~:7..~'. !. & .~...~:T. T. ~..'~"x..~- ~' ..................... b. Intended use and occupancy ............ . .~...~. .... .~./.~ .C: .'~.. ................. .............. 3. Nature of work (check which applicable): New Building .......... Addition .. ! ........ Alteration .......... Repair .............. RemovaI .............. Demolition ........... i... Other Work ...... i (Descriplion) 4. Estimated Cost. /.~..O...... .... ................ Fee .......... : ........................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling un/is on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each tybe of use ..... · .......... 7, Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............... ight ' He ............... Number of Stories ............................ i ............................ Dimensions'of same structure with alterations or additions: Front Rear Depth ...................... Height ...................... Number of/Stories ...................... Dimensions of entire new construction: Front .......... ' ..... Rear ............... Depth .......; ....... Height Number of Stories ' 9. Size of lot: Front ...................... Rear ...................... iDepth ...................... 10. Date of Purchase ............................. Name of Former Owner ,' 11. Zone or use district in which premises are situated ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ............... i ....Phone No ................ Name of Architect ........................... Address .............. i ... Phone No ................ Name of Contractor .......................... Address ' ' .. Phone No. 15. I$ this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. 1 PLOT DIAGRAM Locate clearly and distinctly alt 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 indite, re whether interior or corner lot. S~P[~[~I~[~ ~ ~ NO'YI~ EUI~ ~I¥O~I~IA~=NT AT 7~6-1802 g AM TO 4 lam FOR THE FOLLOWING INSPECTIONS: --'8. 1, FOUN_DATION ,.. FOR , UReO CON m · 3. INSU~ 4, FINAL - CON~TR~N MU~T BECOMPL~E FOR C.C. ALL CONSTRUCTION SHALL ME~ THE R;QUIREME~ OF T~ N,Y, STATE CONOT~ON · ENERGY CODES N~ RES~NSIB~ FOR ~ESIG~, OR CONSTRU~ION ERRORS work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .................. No. ~g~ mm~as~n ~ires O~m~r 8. 1 ~ STATE OF NEWcXO~p,,~.4~~ (.~. ' COUNTY OF . . . -~...(A..'gF~T4 . . S.S ~: ..... C a. ' ~, · · ¢ ............ being duly sworn, depbses and says that he is the applicant (Name ~ individual signing contract) above named, i He is the ................................................................ (Contractor, agent, corporate officer, etc~') of said owner or owners, ~d is duly authorized to perform or have performed the ~said work and to m~e and file this application; that all statements contained ~ this application are' true to the best of h~s knowledge and behef; and that the (Signature of applicant)