The URL can be used to link to this page

Home My WebLink About23598-zTO~N O~ $OUTHOLD BUILDING D£P~I/TM~NT TO~VN SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 23598 o~,o ... ~ ~ . .. ,~.~.~. Permission is hereby g,~/~ ;~: /~./~.~. _. ~/.~.~.,~., .~.~.,..~...////~,~.. .......... ............... .......... ~ ......... ~..~~.~...~...~..~ .......... ~ .......... ~ · . ............................... ~,...~...~ ....................... .................................................................. ~..~..~x....~ ........................................ Building Inspector. F.. ,..Z~.~ ...... Rev. 6/30/80 i DATE COI4HENTS FOIINI)AT 1 ON (IST) FOONI}AT~ON (2NI)) ROIIGll FRAHE & J PLUI'I B 1 NG INSII[.ATION PER N. Y. {,I CODE .......... i{ ................................................................... ADDITIONAL COMI~ENTS: Examined . . Approved . .~ Disapproved a FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ,:?.(l[!q! t3 ~ , TEL.: 765-1802 Permit No. lng APPX-fCATION FOR BUILDING PERMIT B~)ARD OF HEALTH 3 SETS OF PLANS SURVEY .................. CIIECK . CALL . · · · INSTRUCTIONS · a. This 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 st['eets or areas, and giving a detailed description of layout of property muJt 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 Permif pursuant to the Building Zone Ordlh~an~e 0X t}~e TOwn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the ,con~t~qtj0n .of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant"aEFE~ to comply with all applicable taws, ordinances, building code, housing code, and regulations, and to admit authorized inslSec~ors on premises and in building for necessary.~p~ins. ' "' ' ::~ ' ' - ,...' .,..,~/:-~r..,..(~k.~./.~' ' ........ (Signature of applicant, or,flame, if~ corporation) (Mailing address of applicant) State whether-applicant !s owner, lessee 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. · ....... n' ....... ; ~f;;c~ the tax roll or latest deed):"~'" ' ~' '"'' ""' '~'~ I f apph can ~t*O:~;;la;;~'J ~s~ /ture o; du y authorized : (Name and title of corporate officer) - Builder's License No.' ................ ' ......... Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be'done ............ : House Number Street Hamlet Couhty Tax Map No. 1000 Section ....'~.~. .......... Block ..~.. ...... ' .. Lot..~..~. ............ Subdivision...~l.~..../~...~...~.. ............ '. Filed Map No ............... Lot ............... (Name) Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: .3. Nature of work (check which oPplicable): New Building .......... Addition .......... Alteration ....... }.. Repair· Removal ' ' Demolition Other Work . ' ' ~ (Descr n 4. Estimated 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 ' · ' ' Cd ify h typ .6. If business, commercial or mix occupancy, spec nature and extent of.eat e of use ..................... 7. Dimensions of existing structm'es, if any: Front'.. ~ ............ Rear .............. Depth .............. Height ............... ~umber of Stories ..... ~ .................. ' ................. With ... ........... ' ............. · Dimensions of shme structur~ alterations or additions: Front Rear ............... D.epth · ' ~ ...... ~ ...... ~,,, ................... ,.. l~umoer of Stones ....... ' ' 8. D,mensions of entire new construction. Front ........ ; Rear ....... De th .............. Height ............ Number of Stories . . ...... Size of lot Front i . .. ' ...... ' ......................... 9.~ . ~-" ' "'"'"i .......... ~ear ...................... Depth .................... 10. ~Jate ox t'urchase .......... ~ .......... . ......... Name of Former Owner ........................... 11. Zone or use district in which p!emises are situated .12. D°es proposed construction vidlate any zoning law, ordina~ce or regulation: 13. Will 10t be regraded ' ! .............................. ........ . .................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises i Address ' · · .......... ; ........................... Phone No ............ ; .... Name of Architect i ' Address Phone No ' Name of Contractor . Address Phone No ' 15.' I.s this property within i300 feet of a tidal wetland? *Yes ...... No ...... · If yes, Southold iTown Trustees Permit may be requirg~. ' ''' · i PLOT DIAGRAM Locate clearly and distinctly ali buildings, Whether existing or proposed, and. indicate all set-back dimensions fro~ property lines. Give street and blocklnumber or description according to deed; and show street names and indicate whether interior or corner lot. · cV°R US[' tS'U VL WFOL. . . W TI' OUT CERTiFiCATE OF OCCUPAncy ~APPROVED AS NOTED ~ ~., FEE: ~B~ :' - N~IW BUILDING DEP~ 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPEC~ONS: ~,' FOUNDATION . ~0 REOUIRED , FOR POURED CONCR~E 2, ROUGH - F~MING & PLUMBING 3. INSU~TION 4. FINAL CON~RU~ON MU~ BE COMPL~E ~R C.O. ALL CONSTRU~ON ~ ME~ THE REQUlREME~ OF ~E N.~ STA~ CONS~U~ON & ~ERGY CODES. N~ RES~NSIB~ ~R DESIGN OR ~~ STATE OF NEW YO~RI~ _ S S ' COUNTY, .OF .... (Name of individual signi contract) above named. being duly sworn, depose~ and says that he is the applicant ~',He is the . .' ...................... ~ ~o ' ' ! (Contracto ri~orate officer, etc.) ' ' of said owner or owners, and is dulJ authorized to perT'm:m-~r have performed the said work and to make and file this application; that all statements contained in this'application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before me this ~ i ' ..... . ...... · .4Y'vf ......... -t ........... .'/ ( '" _ NOTARYP~8'LIC, SIateofN.Y, . ''v'" ..... """-~-~'~-~%~:"'L . .'~-'-,--~-,-'~-~.'.'''- (S,gnature of apphcant) · . ' ' ' ' Term _~xpif:eS May 31,192.~..~ " . '