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Home My WebLink About18907-ZTOWN 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) N~- 18907 Z Permission is hereby granted to: .................. .~...~.:¥.:.....!..:.~. ..~. ..l ...... ~o ~.......o,~....,~...~....~~..,. ....... ~....~.,~...~ County Tax Map No. 1000 Section ...... .(~...~..I ........ Block ......(~....~:.. ....... Lot No ...... l..~;~ ............. pursuant to application dated .....~.~r~.....~....~. ................... 19.~..°..., and approved by the Building Inspector. Fee $./...L3...:...~ Rev. 6/30/80 FORM NO. 1 TOWN OF £OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. '1197'1 TEL,: 765-1802 Examined ............ ~. . ~- 7..~.. Approved..V."~. i ¢~,~-c~.... )., 19c/.~. Permit No.,/..~f.~. Disapproved a/c .................................... . ................................'' .... ; (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY; CALL .7¢~:t ~./~ .......... MAIL TO: Date ,~./..c~. .......... 19 ~ a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 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 par~ of this cation. ¢. The work covered by th.is 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 a0y 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, Ordin:mces 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, building code. housing code, and regulations, and to admit authorized inspector~ on premises and in buildino" for necessary i~s~i~s_. ~., · .. · /..(.oN:."7 ........ ~'I'ailir~ .~c~/r'e'ss of applican;) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ..... (~ame a~fi title ~f corpor'ate ............... officer) Builder's License No ....... ~X' .................. Plumber's License No ........ ~,,~. ............... Electrician's License No ........ .~,. ............ Other Trade's License No 1. Location of land on which proposed work will bc done$ House Number Street, Hamlet ...... ' .......... .... Subdivision ..................................... Eilcd Map No ............... Lot ........ (Name) 2. 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 ..... ~ ..................... 3. Nature of work (check which applicable): New Buildin, n~g-- - -. Addition .......... Alteration ........... Repair ....... R~moval ........ ~. Demolitioll---r-~..,.~..~. . . .Swi,.n~,in~.~pol{. ,,.~ ........ Tennis Court ......... Accessory Buxld~ng ......... Fence ...... ~he;J~r~.- ......... 4. Estimated Cost ......................... Fee ......... '... 7.... ~ ..... ~ ........... · · (to be paid ~n filiRg,,tliis'application) 5. If dxvelling, number of dxvclline unitS,,~ .............. Number of dwelling units on each floor ................. ]rgarage. numherofcars gA .......... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................... 7. Dime:~sions of existing structures, it' any: Front ............... Rear ............... Depth ................ Height ............... Number ct' Stories ......................................................... Dimensions of same structure with alterations or additions: Front Rear ............. Depth ...................... Height ...................... Number ct' Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ................ Height .............. Number of St0ries .............. ; .......................................... 9. Size of lot: Front ...................... Rear ...................... Depth ....................... 10. Date of Purchase .. a.i. ff.~ ..................... Name of Former Owner .. ~ t ¢?.'-~9~ ................... 1 I. Zone or use district in which premises are situated...~.~'<L°,... ~ .-~.. ...................................... 12. Does proposed constructmn Wolate any zoning taw, ordinance or regulanon: .. ~?/-. ............ 13. WU! lot be regraded . ;../~.0. .................... Will excess fill be removed from premises:'' ._Yes. ~ · : 14, Name of Owner of premmes /~j,~..j .?~..~..4~ ...... Address /tD.4.~. Y.q. ?k/.6.~... Phone No. of Architect Address Phone No Name of. Contractor ................. i .. ....... Address ................ Phon~No ..... ~ ... ~ Z .... 15.Is this property located within JO0 feet of a tidal wetlaud? -YES .... NO.,~. mil yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicat~ all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whethe .r, interior or comer lot. APPKOVED AS ~0';';~D 0~' 765-1802 9 A~ TO a P;',~ FO~ file FOLLOWING (NSPEC1 IOfi~& 1. gOUNDADON ~'0 REQUIRED FO~ POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONSTRUCTION ~tJST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ON & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF..¢.~'..F-/Tg- ~.~ .... S.S ........ ,..., LO....__ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I% is the ~,~,~o~ . (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to pezform Or have perfo~ed the said work and to m~e 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 w~l be perl3m~ed in the re=ncr set forth in the application Hied therewith. Sworn to before me this .............. ....... or ........ ..... ~ffiE~[ ......... ~. e .................... - . ~ ~IC ~ d ~ ~ ,~ - (Signature o f applic~t) _ ~ 4707878, Sufl~k ~/ ~ h~ ~h ~la~ ~t