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Home My WebLink About17714-z i~ORM NO, · TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 51?71 Z County Tax Mop No '1000 Section ...~ .~..... Block ....... ~ ......... Lot No ..... ...~.c/.. pursuant to application dated ................. Building Inspector. Fee $.'~~ ., )9..~.4~., and approved by the Rev 6/30/80 BOARD OF MEALTlt ...... " 3 SETS OF PLANS ....... 'FOnMNO, I SURVEY ......... TOWN OF SOUTHOLD CI1ECK .... , ..... BUILDING DEPARTMENT SEPTIC FORH TOWN HALL NOTIFY $OUTHOLD, N,Y. 11971 TEL.: 765-1B02 Examined ~D./~. '2. 19 ~'t~ ..... .... ......... .... ~ ?~ ~ APPLICATION FOR BUILDING PER~IT INSTRUCTIONS CALL ................ MAIL TO: a. Tins application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, v sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public s or areas, and giving a detmled descnptxon of layout of property must be drawn on the diagram which is part of this - cation. c. The work covered by ttus application may not be commenced before issuance of Budding Permit. d. Upon approval of thru apphcahon, the Building Inspector will issued a Bmldmg Permit to the applicant. Such p shall be kept on the premises available for mspechon throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occu~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinant Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desc~ The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, ai admit authorized inspectors on premises and in building for necessary inspections. ...N..~.4& .,5.~(. ~ ......... (Signature of applicant, or name, if a corporation) .... ~..q .t~...~..~.~. ,°m.a_~. u (Marling address of applicant) '-;t,lte wllether avPh/~t ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or but ............ ~......)~)~.~ ~ .................~, ............... ,,' ............................. N,ime o[' It ,lpphcal]t is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... Plulnber's License No ................ Electrician's License No ............... Other Trade's License No ............... Locabou of land on winch proposed work w~ll be done ............................................ ........ ....... ....... ....... lIouse Number Street Hamlet County Tax Map No IOOO Section ....... g,--~. ..... Block .... ~ ........... Lot .~.: ./. ........ Subdlvmlon ....................... Fded Map No .............. Lot ............ (Name) State existing use and occupancy of prenuses and intended use and occupancy of proposed construction a Existing use and occupancy ............................................ b Intended use and occupancy 3. turc of work (check wb~cb applicable) New Building ..... ' ..... Addition .......... Alterat.~ ..... .............. r e,,,ova .............. Demol.ion ............. Other Wor . (Descrlpliol 4 EstunatedCost ....... ........~ .............. .. ... ., Fee . ........... .. ..... ... .... · .. " (to be paid on fil,ng this apphcatiou) 5 If dwelling, number of dwelling units .............. Number of dwelling units on each floor ............ If garage, number of cars ..................................................................... 6 If bus~ness, commercml or m~xed occupancy, specify nature and extent of each type of use ................. 7 D~mensions of exisnng structures, if any. Front ............... Rear .............. Depth ........... tte~ght ............... Number of Stories ................................................... Dm~ensions of same structure with alterations or additions. Front ................ Rear .............. Depth ..................... Height ...................... Number of Stones .................. 8. Dmlensions of entire new construction: Front ............... Rear ............... Depth ........... Ileight ............... Number of Stones .................................................... Size of lot Front .................... Rear ...................... Depth ................ Date of Purchase ............................ Name of Former Owner ........................ Zone or use d~stnct in which premises are situated .................. Does proposed construction violate any zoning law, ordinance or regulation: ............................. Will lot be regraded .......................... Wdl exce~s fill be removed fronl premises: _ Yes~ Name of Owner of premises ~-~ .('~it~gS,-~.. Address ~th,~lone mo Name of Architect .,, .................t3 N ...... Address ................... Phone No ............ Nmne of Contractor .~. Ok.~ .~....~,~. ~.....--o-2L'~-4~..~.~ AddressQ. g ~.qq'/o.. 6-~O~. Phone No. c~ 15. Is this property located wit[in 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Tow~ Trustees Permit maybe required. PLOT DIAGRAM Locate clearJy and distinctly ~! buddings, whether existing or proposed, and mdma~e ali set-back dimensions f property hnes. Give street and block number or description according to deed, and show street names and indicate whe interior or corner lot. 9 10 11 12 13. 14 APgROV EQ_A$ NOTED / FEE ~BY: ~ NOTIFy,~ruII.~G DEPARTMEJ~I' AT 7~6-1802 9 AM TO 4 PM FOR T~E FOLLOWING INSPECTIONS. 1. FOUNDATION - TWO REQUI~ED FOR ROUflED CONCRET~ 2. ROUGH - FRAMING & PLUMBING 3 INSULAI~ON 4 FINAL CONSTRUCTION MUST SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIR~ENT~ OF 'FHE N.Y. STATE CON91~JCIION & ENERGY CODES, NOT 8L~IJ~ISffiL~ FOR OES~GN OR CONSTRUCTION ERROR~ STATE OF NEW YORK, S.S COUNTY OF ............ · · i .................... being duly sworn, deposes and says that he is the apph (Name of mdwidual s~gmng contract) above ilanled. ~s the ~4D~?.~. · · lie (Contractor, agent, corporate officer, etc.) of smd owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e ~d file apphcatmn; that all statements, contained ~ this apphcat~on are true to the best of his ~owledg* and belief; and tha work will be perfo~ed m the m~ner set for~ m the application filed therewith. Sworn to before me tins ........... ........ aY°f ...... .......... ~EN ~ OE ~E . . ......... ~ PUSLI~ ~ ~ ~w Y~ (Signature of apph,