HomeMy WebLinkAbout17255-z BOARD OF HEALTH
FORMNO.1 3 SETS OF PL.1NS
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•oarl
TOWN HALL
SOUTHOLD, N.Y. 11~J71 NOTIFY /
TEL.:765~1802 CALL .7~~,~~°~/
Examined . a.L 19~ g MAIL T0: .
,approved , „ 19gg. Permit No. I.7~.SS
Disapproved a/c
~~di..::
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ r5.', 15~'~
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter 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 layout 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.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building far necessary inspections.
r~ ~~~e.®~;-ems .
(Sigtlpture oi" applica , or name, if a corporatton)
053•ao .1nA1.N .~oA~,soU~.HOLD,~I.Y.. ~,?97?.... .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.........owNE~ #PPROVE9•IFSNOTEd.......
Name of owner of premises ,DOROTHY AND SALVATORE DI CHIARA PATE. ~ it tea' S,P q S'~
(as on the tax roll or latest~.lS BY: V
[f applicant is a corporation, signature of duly authorized officer. Nom' ` °vI~tNG OEPARTM'
~
q
76b•1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
t. FOUNDATION
(Name and title of corporate officer) TWO REQUIRED
. FOR POURED CONCRETE
Builder's License No. 2. ROUGH -FRAMING & PLUMBING
3.tNSULATION
Plumber's License No. 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
Electrician's License No. All CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTtpp ~ ENERGY
Other Trade's License No . COOE& NOt
REBPONSIBtE FOR
1. Location of land on which proposed work will be done. 45,00, MAIN ROAD, S~~I~~~Ug~OjNFRRORS
Flouse Number .......................Strcet~ .;....................Hamlet........................
1 ,
County Tax ibtap No. 1000 Section ..0.7.5.00.......... Blgck 0600 009002
Lot...................
Subdivision Filed Afap No. Lot .
(Name)
e
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy FENCE AROUND YARD ,
I! ?p
3. Naturrof work (check a'hiRhm plicable): New Building , , , , Addition , teration
Repair , , R U . , ,
• • • • • oval Demolition Other 1Vork . • ~ • ~ •
4. Estimated CosY~.!f , C~~-~, : (Description)
Fee
5. If dwelling g' (to be paid on Cling this application)
n number of dwcllin units Number of dwelling units on each floor , ,
If gara,c, number of cars
6. If businss, commercial or mixed occupancy, specify nature and extent of each type of use • •
7. Dimensions of existing structures, if any: Front . ' ' ' ' ' ' • • • • • • • • • • • .
Height Number of Stories . Rear Depth .
Dimensions of same structure with alterations or additions: Front • ~ ~ • ~ • • ~ • ' ' '
D<:pth . IIcig}tt . Rear .
8. Dimensions of entire new construction: Front , ~ • ' ' ' ' ' • • • • Number of Stories . . .
Height , Number of Stories Rear , Depth , , .
9. Size of lot: Front Rear
10, Date of Purchase I Depth
P p •'•••••••••••....NameofFotmerOwner
11, Zone or,use district in which premises are situated . . . . . . ~ • • • ~ ~ ~ • ~ • ' ' ' ' ' ' ' '
12. Does ro osed construction violtjtc any zoning law, ordinance or rcgu]ation: • ~ •
13. Nill lot be regraded ' Will excess fill be removed from premises: .Yes No
14. Name of Owner of premises • , ~ • • • • • ' ' '
Name of Architect • ' • ' ' ' ' ' ' ' ' • • Address . .............Phone No....... .
Name of ..................Phone No..
Contractor .Address . ' ' ' ' ' ' ' '
IS.Is this property located within •"Address ,PhoneNo.....
*I£ yes, Southold Townl,Trustees Peruritemay bearequiredetland? *YES....NO....
PLOT DIAGRAM
Locate clearly and distinctly all t?uildings, whether existing or proposed, and. indicate all set-back dimensions from
property Gnes. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot:
i ~e
n
~K~~~
e:~~ 4#ii~ : ~ t~~t'~Q~ ~i~
.;,,';i,t t;'- t k;r4 7s~tt(3.::"rJ~ Y~1 /
~i6~sr t{it '~~'i t tii Pi?~ F~. ~~t'
y~rp,,,lti~Ni
3TATE.O~,N4~~1~~(AiR)itstCta tt ='?i'1 ~A
~OUNTI~"~~' ,fS_J•fltJa d7~ r;SR+#te`3
t~VtiY? .~.p
• A
p
N~~~arrl~o ~ t1I ' ' ' ' ' ' ' ' ' ' ' • • • • being duly sworn, deposes and says that he is the a
bove nlttUtfiallel~ i ~ t~~ni~>~'~°ntract) Pplicant
~yy~ ~pp~~~1C'li~flyp ~t.y~'~~i±.`
1;60. pRL.J ~Q 11urPil~r
rt~~#
• er
fersth~g2..:....:.... own
y au (Contractor, agent, corporate officer, etc.) ~ • ~ • • ' ' ' ' ' ' '
f said owner or owners, and is dul thorized to perform or have performed the said work and to make and file this
tPlication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
ork will be pcrt,'ormed in Ilse manner sell forth in the application filed therewith.
•vorn to before me thigqs
..day of I''i............ ,19~.
Mary Public, ......Jd/o 0 ~~VVV~~(((/// , , County
YeAt , c~. ~ .
NO'bRY4~
~ ~~~u~
TamEnt~h30.1>~ (Si;nature of applicant)
'