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Home My WebLink About17277-z ~0~ NO. ~ 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) 017277 Z Permission is hereby granted to: ,n -~ Coun~ Tax Mop No. 1000 Section ....... /.~.P,.. Bilk ............. ~.... Lot No ............. Z ....... pursuant to application dated ............................... ~ ................., 19_ and Building Inspector. Fee $... 0~...~ approved by the Rev. 6/30/80 'x, VI L L I Al,/! \VIC~HAM BOARD OF HEALTH ...... 3 SETS OF PLANS ....... ~FOMM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL ~OUTHOLD, N.Y. 11971 , / TEL.: 765-1803 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT NOTIFY CALL -')-'~. ¢'~' -d - 7, ~ -~- (~ ..... MAIL TO: Date ................... 19... INSTRUCTIONS a. This 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 prenii~es, relationship to adjoining premises or pubhc 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. N~ building shail be ~ccupied ~r used in wh~le ~rin part f~r any purp~se whatev¢r until a Certi~cate ~f Occupancy shall have been granted by th~ Building Inspector. APPLICATION IS HEREBY MADE to the Building Departm. ent 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 or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and to admit authorized insge~tQrs, on~p~e~is?%and in building for necessary inspections. ................. ~ ...... " ...... (Signature of a~h~dant, or name, if a corporation) ~,.'i ;!~,' .. '~ ,. ' ' (Mailing ~ddress of applicant) State whethe~r ~z~a~ zs, ewner, ]es~e'e; agent, ~chitect, engineer, general contractor, electrician, plumber or builder. ......... R": .:. :'.'. % .......................................................... ' Name of owner of premzses .~.. ~/{z ~-'~ T <5'J~¢ ~ ~_~ , .. (as on the tax. roll or latest deed) If applicant is a o~rporation; signature.of duly authorized officer. (Name,and title of co.orate officer) AL~ CONTRACTOR'S MUST. BIB SUFF.O.~K COUNTY L~CV.~SF.D Builder's License No .... ].q. rO .~.~.. ~ ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. I000 Section ...... ~0~. ........ Block .... ~ ............ Lot ..... / ............. Subdivision ..................................... Filed Map No ............... Lot ... ~ ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of p~roposed construction: E i ti eh d p fl~ ~-~c~.i~ 6-~& a. xs ngus n 'occu a cy ....................................................... b. Intended use and occupan~/ 3. Nature o work (check which apphcable): New Building .......... Addition .......... Alterati. gn .......... Repair ' ~ ' · .............. Remoyal .............. Demoht~on .............. Other Work..~.~. (~.c. ~ ...... . (Descr 4. Estimated Cost ............................... Fee ...................................... ' · (to be paid on filing this application) 5. If dwelling, number of dwelling ffnits.. .............. Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixedloccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures', if any: Front ............... Rear .............. Depth ............... Height ............... Numl~er of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth. .................... ;. Height ...................... Number of Stories ...................... --8. Dimensions ' ' ' · Rear .............. Depth ............... of entire new construction: Front ......... . ...... Height ............. ;/flu_~p2~.~_o f Stones ........................................................ 9. Size of lot: Front .... ~ .... ~ .... Rear ...................... Depth ...................... 10. Date of Purchase . . - 11. Zone or use district in which premises are situated ......................... 12. Does proposed construction vioI~te any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... ~ .................. Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises .... ................ Address ................... Phone No ............ Nme of Architect ' Address Phone No Name of Contractor ....... ' Address .... ; .............. Phone No\2 ............... 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trm tees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all 2uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block r umber or description according to deed, and show street names and indicate whether interior or corner lot. ApPRO'/tED AS NOTED , / ~ . FEE: 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - ~ REQUIRED FOR POURED CONCRI~TE 2, ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINAL - coNSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION ~HALL MEET THE REQUIREMENT8 OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONEIBLE FOR' DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.S COUN'I~Y O,F .... ,' · ' ~, ......... I ' "~' '~' ~~~ .... i .....,...: .......... being duly sworn, deposes and-says that he is the applicant He is the ~ --. ........................... , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~xd work and to make and file this application that all statements contained in this application are true to the best of his t~wledge and belief; and that the work will be .performed in the manner set forth in the application filed therewith. Sworn to before me this ..................... day of ............ , . . . ~OTARY PUBLIC, State of NeW York .,. No, 4707878, Suffolk Cou,ty ~ mrm Ex,res March $O,,19,T.Lq.~ .... C°unty(~X F'N - ~ ...... '~ ' '~' ' ' '~' ' ' ' ~:e'J~ J;OliJa'n'ti