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Home My WebLink About18930-ZTOWN OF SOU'/HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISF.5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 18930 Z Permission is hereby granted to: ....... .q...{..~7_~...~..:. ........................ ...... ~~.-~.~...A..~.,....u.~.r ~... .......... ................... at premises located at .....~../..~.....~......~,.: ........ ..'~.~.~.~..~ .................. County Tax Map No. 1000 Sectio~/~.~../J'.....'~... ...... Block ....... C~.J ......... Lot No .......C~....'] ............ pursuant to application dated .... ..~.~/~.~.,,....~....oj .................. , 19..¢r....~., and approved by the Building Inspector. Fee ......... : .............. Rev. 6/30/80 Examincd. .M~q44~....~-..., 19~.q Approved~...-'~..., 19~-O. Permit No. }.......... ~? ~ ~ ~ ....................... .... (Building Inspector) APPLIgATION FOFI BUILDING PEHMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ FORr~I NO. t SURVEY , - .................... TOWN OF SOUTHOLD CSECK ...................... BUILDING DEPARTMENT SEPTIC FORM ................ TOWN HALL $OUTHOLD, N.Y. 11971 NOTIYY; TEL.: 765-1B02 CALL .c~ ].oO.':. ~'.7.2 7. ....... MAIL TO: INSTRUCTIONS a. Tiffs 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premi~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of th.is appLi- cation. o. 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 throuc2nout the work. e. No building shall be occupied or used in whole or in part for spy 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 appIicable Law~, Ordinancex or Regulations, for the construction o£ buildings, additions or alterations, or for removal or demolition, a~ herein described. Tile applicant agrees to comply with all applicable laws, ordinances, building code, housin; code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections., . . (Signature of applicant" ', or' name, if a ~orpora~mn) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises 4~.%v~° ................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ....... a,;d t;ti , 'c0rpor te mcer) Builder's License No & Plumber's License No ...... ~ ............. Electrician's License No ..... . .c,~%_..~ .... Oilier Trade's License No Location of land on which proposad work will be done, House Num bet Street: Hamlet Jl .c~ Block I. Lot '~. " County Tax Map No I000 Section ' ' /' Subdivision .................................... Eiled Map No. .. .. Lot (Name) State existing nsc and occupancy of premises and., .,~ , _intended nsc and occnpancy of proposed constrnction: ' -- a. E ' ' _ ~ ~, .L,~$:: ...... x]stmg use and occupancy ..........%-~'~..cgl.. ~ .~ .~,,,~,~:.;,.~ ;%, . -, ~ ...,. . . ntended use and occupancy ........ ........ .....,?.,%.,, ..................... . 3. Nature of work (c.~eck which applicable): New Building .......... _A~d~icn ...'; _ ,~J£cration ..... r ..... Repair .............. R~moval .............. Demolition ~ .i;;~i.'ataing poor ..... ~ .' ..... 4. Eatimated Coat .............. Fee ............. , ................. thi~ ts~on. Eac 5. If dwcliin=, uumbcr o~ d~vcl[in~ units ............... Number o~ dwcllin~ uni hfloor ............... IE ==r=~ number of cars ..... 6. If business, commercial or mi~cd occupancy, specify nature ~nd c~tcnt o~ c~ch type o~ usc .................... 7. Dimensions of cxis$in~ s[~cturcs, i~ any: Fro~ ............... Rear ............... Depth .............. Height .............. ~umbct o~ Stones .......... Dimensions of same st~cturc with alterations or additions: Front ................. Rear ................ . Depth ...................... HeiSt ...................... Number of Stories ...................... 8. Dimensionsofentirenewconstmction:Front............... Rear .... .......... . Depth ........... .. . . . Height ............... Number of St0fics .............. ; .......................................... 9. Size of lot: Front ....... Rea.- Depth ................. 10. Date of Purch~e ............................. Name of Foyer Owner .............................. 11. Zone or use district in which premises are situated ...................................................... 1_. Does proposed construction violate any zoning law, ordinance or regulation: ................................. 13. W~I lot be regmded .; .......................... Will excess fill be rc~oved from premises: . Yes .... Na.. 14. N~eofOwnerofpremises ................' .... Address .. ....... .......... PhoneNo ................. N~e of Architect Address Phone No ...... N~e of Contractor ' Address Phone No 15.Xs ~his p=operty located ~ithin ~00 ~eeC of a ~idal wetland? ~YES .... ~O .... ~X~ yes, Sou~hold To~n TrusEees Permi~ may be required. PLOT DIAG~M Locate cle~ly ~d dis~ctly ~1 bu~d~gs, whether existing or proposed, ~d. indicate El set-back d~ensions from progeny ~nes. Giw street ~d block number or description accord~g to deed, ~d show street n~es and ~dicate whether interior or corner lot. NOTIFY BUILDING OEPART,'~ENT AT 765-1RO2 9 ~nA TO a PM FOR THE FOLLOWING iNSPECTIONS. 1. FOUNDATION TWO REQUIRED FOR POURED CONCEETE 2. ROUGH - FRAMING & PLUMBING FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW ~60 RKo~j COUNTY OF...~.C.t l. {Name of individual signing contract) above named. ..... being duly sworn, deposes and says that he is the applicant He is the ......................... ~-~:--,,,. ..... - ....................... ; .... of said own o~vners, and is duly authorize~e,rform or have performed the said ~vork and o is application; that all statements contained in this application are trne to the best of his knowledge and belief; and that the Work will be perlbrn~cd in tile manner set forth in thc application filed therewith. .' Sworn to before mc this ' '.~i .................~~~'~'' .day ~ ....... 1~ Notary Public .... ~~ .... County Cl.~ ~ ~L~W No~q~ P.b#o. ~.te of New Yo~ No. 4879506 OuMlfled in Suffolk CounW (Signamr~ of applic~t)