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Home My WebLink About22295-Z FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTIIOLD, N.Y. 11971 TEL.: 755- 1802 Examined ,. ~ ........... 19 ~ ....... · , 5/: ~ it No. Disapproved a/c ................................ ~ .... .. .................. APPLICATION FOR BUILDINGPERMIT SETS OF SURVEY ........ CllECK CALL I'IA I L TO; Date . . ....... 19~. ' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Hot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. ' e. ' 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 i~sued a Building Permit to the applicant. Such perml 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 Occupanc~ shall have been granted by the Bui'Idi, uad~ctor ' · APPLICATION ISt~]~.,MADE to the Building De artm' ' · Building Zone Ordinance of t~i:~ Town of S~,--~ ...... !P_ ent for the zssuance of a Building Permit pursuant to the uut~zu~u, 'buIIOlK tZount¥, New York, and other applicable Laws Ordinances or Regulations, for thc construction of.buildings, additions or alterations, or for removal or demolition, as herein. ' describe::. The applicant agrees to comply with all applicable laws, ordinances b ' ' - admit authorized inspectors on premises an~l in building, e ........... ,: ufld~g code, hou ng code, and regulations and to ' //7 (Signat.9,ure of · ' ' ' ' / (Mailing address of apt~hcant) (..] ' State whether, j~_.plicant is,owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or bml . ...... : (asdn the tax roll or latest deedi - ' ~f ................ If applicant is a corporation, signature of duly authorized officer.' ' (Name and title of corporate officer) Builder's License No. Plumber's License ~o.. Other Trade's License No .. ' House ~,,,~ber U " ~ .... C~ir;;i ............. . . . ...~;~'~0~. : ........ Cotmt¥ Tax Map~o. I000 Section: .... .. ~.~ ......... .... ........ ' (~,:a~nc) ..... Filed Map No. ............. :. Lot ........ State ex/sling usc and occupancy o£premiscs and intended use and occupancy of proposed construction: ' ' ...... a. Existing usc and occupancy .... ' .... : .......... , .......... - ' ' .......... ';i ..................... ,. Nature ofwoik (check which applicable): New Buildi - Addition .......... Alteration ........ Repair .............. Removal .............. Demolition .... : ......... Other Work ............. . (Dcs:ription) 4. Estimated Cost O e~9 - Fee . .-:3..~..7.~. ! ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Numbcrofdwcllingunits on each floor ............... . If garage, number of cars ......................................... . .............................. 6. If business, commercial or mixed occupancy, specify nature and ex tent of.each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth Height ...... · ......... Num bet of Stories ............... Dimensions of shine structure with alterations or additions: Front · · ................ Rear ................. Depth Height ........... - ........ , · · Number of Stories ......... '.. ~'~.. 8. Dimensions of entire new construction: Front.. i~.' .......... , Rear ............... Depth .............. Height ............... Number of Stories 'I~ .................. 9. Size oflot: Front ......... , ...... . .... L.. ar ' ' ~ ....... i ....................... I0. Date of Purchase ...................... Dep h ..................... .. -. . .................... ' ......... Name of Former Owner ..................... 11. Lone or use district in which premises are situated ............ .................... 12. Does proposed construction violate any zoning law, ordinance or regulation . . .... 13. Will 10t be reoraded ' · · : ' ' ........................ -~ - 14. x~ _~ ,-, ~ ~ '' '.'' 'x~'~;~f4'.t~2 '; '1~;: 77 ': .... Will excess fill be removed from premises: ~,,m~ m ~wner o~ p~renp~sest~e~.~. ~ ~//-g4. l 'ffPrl?' Add .......... ~2.4,~--~ z-,t/j_ Name ' · ', · ~-r T ................... rhone rcm -r~.¥ .;..e,~TT...'; . Name o°ff ~A~rc-h*~L~'~'~ .......... Address ~/c';f.~.~~;hone No..~ .................... -- Address U Phone No ' 15.' I.s th±s property within 300 feet of a tidal wetlandV''',~e's ......... ~,;~ '<~- ' ''; ............ · *If yes, Southold To · ' ............ ""' ..... wn Trustees Permzt may be required. ' .... PLOT DIAGRAM Locate clearly an~ distinctly all buildings, ~heth~r 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 indicate whether b~terior or corner lot. ' APPROVED.AS NOTED ' 765-~802 9 AM TO 4 PM ~O~ THE FOLLOWING INSPECTIONS: 1. F~JNDA/ION . ~VO REQUIRED FO~ POURED CONCR~E 2 ROUGH -FRAMING & PLUMBING 3. 'tNSU~TION 4. FINAL .',. CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRU~ION SHALL THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CONSTRU~ION ERRORS rATE O~ NEW YO RI(, S S ..... ~'"' '": ...... : :.~ ..... ' · :- ·: :. ~ ........... being duly sworn, deposes ~d says that he is the applicant " (Name of individual signing contract) )OVC ~amcd. (Contractor, agent, corporate officer, crc ) - said owner or owners, ~d is duly auti;orizcd to perform or have pcrfomncd thc said work and to make and file this ~ticat on; that all statements contained ~ this application arc tru~ to thc best of his knowledge and belief; and that ~e :rk will be perfo~cd in thc manner set Yorth in Hm application filed therewith. om to before me this