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Home My WebLink About19172-ZTOWN OF SOU'DIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ '; ~l 77 Z Permission is hereby granted to: at p~mi~s located at , , County Tax Mop No. 1000 Section ....k~..~. .......... Block ...... ..~...~. ......... Lot No ......~....:..,! .......... pursuant to application dated ........ ..~.~ ....... ..~...'~.. .................. , 19.~..D..., and approved by the / Building Inspector. building Inspector ) Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 1'1971 TEL.: 7G5-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC ¥ORH ................ Approved . ..~'.., 19 ?P. Permit No. l .~..}. ?..~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERIVllT NOTIFY~ CALL ........... MAIL TO: Date . ........... 19... INSTRUCTIONS a. Tiffs 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 t~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 arkas, and giving a deta/led description of layout of property must be drawn on the diagram which is part of th.is appli- cation. ¢. The work covered by th/~ 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. ¢. No building shall be occupied or used in whole or in part for coy 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 Sbuthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, auditions or alterations, or for iemoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and/n building for necessary inspections. (Signature of hpplicant, or name, if a corporanon) ........... (Mailin=~ address of applicant) State whether applicant is w~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :,". (as on the tax roll or latest deed) ir applicant is a corporation, signature of dul~, authorized r (Name and title of corporate officer) Builder's License No ............. ,.~ ............ Plum bet's License No ........ ..'~ ~ ,. ~, !;: .......... Electrician's License No. . .x .... g.~r~, .~ .......... Other Trade's License No ...................... fiorl, pfland o h p · · ' ' ' 1. Loca n whic roposcd work will be donj~; tlouse Number Street Hamlet 1 0. . / ,. County Tax Map No. I000 Section ............. . Block ................ Lot... ' ..... ,. 8. ...... Subdivision..~m'. ............... Eilcd Map No ...............Lot ............... (Name) h State existing use and occupancy of premises and intended use and occupaqcy of proposed constr)mtion: A. Exlst~ng use and occupan y ............... ~ ................... B Intended and occupancy .............................................. 3. Nature of work (check xvhich applicable): New Building .......... Additi&n .......... Alteration ........... Repair .......... R~moval .............. Demolition ...... .~. ...... Swimming pool_.. Tennis Court ......... Accessory Building .......... Fence ....... OCher ~/ork ............ 4. Estimated Cost ...................................... Fee ..................................... ' ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................. If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................... Hmgbt .... .... .. ,..,..:... er tones ........................................................ Dimensions o£ san~rimc~[u~e~tll alterations or additions: Front ................. Rear ................... Depth .................. .,~im.-_-..~.__ '~ Height ...................... Number of Stories ....................... 8. Dimensions of~cl'~I,stmCtion: Front ............... Rear ............... Depth .......... Hm_.llt ............ .Num ~r of Stones ........... ; ........................................ 9. Size of lot: F:~,o~t'~,. i;7,C:~:?. ;';"] .......... Rear ....... ~ Depth ................... 0. Date of Purchase .i.L..~;'~'.i i'.: i'. ~. of Former Owner ........................ .............. 1. Zone or use district in which premises are situated ................................................ 2. Does proposed construction violate any zoning law, ordinance or regulation: . 3h~ ............................ 3. Will lot be regraded ...... .~.~. ................ wii excess fill be removed from premises: Y/:..~...,,~.. No~-. · - , ~ · ~ 4. Name of Owner of premxses ~:~}.~.¢'.c~C.~;~t~... ..... Address ~JG0~. 0'3~lYd .~.. J-.. P lone No..~..('~.~ .~l ....... Name of Architect ....... r, ............... Address ................... Phone No ........... ^ ..... Name of Contractor-'~l. ~l.~:[~. i.. ii .... Address (O.J~.~.~..I. .~.. Phone No..-~'0.%~. ) 7.~:vja · ,. 15.Is this propertyioqted w'~thin 300 feet of a tidal wetland? *YK$ .... NO.k"-.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and disthactly.all buildings, whether existing or proposed, and. indicate all set-back dimensions from :roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or comer lot. ~ )_ ~"~..~.., , . ~OUNTY OF .2~Jb-r.. ..... ~'2.. (Name of individu ~bovc named. ~ntract) ~00'0 ~1~ ~ ~ -"/_"TAPPROVED ep.AS NOTED FOLLOWIN~ INSF~C '' :' ' FOR POURED 2, ROUGH - FRAMING & 3. INSU~TION 4, FINAL CONSTRUCTIOn'; BE COMPLETE FOR C O ~ CONSTRUCTION $~ALL MEET ~E REQUIREMENTS OF TNE N ~ATE ~NST~ION ~ ENERG~ ~ ~NSIBLE VOR being duly swom~b~~~ (Contractor, agent, corporate Officer, etc.) said owner or owners, and is duly authorized to pc,rform or have performed the said work and to make and file this ~pplication: that all statements contained in this application are true to tile best of his knowledge and belief; and that the .york will be performed in the manner set forth in the application filed therewith. Swam to before me ?3is ' - ...dayo .~ .............. 19.~ ~~ ~ Public. Stat~: , ~'~ ' ~~--Z.' .... %~ ....... ~. ~2~87 S),-~, ~}~ ~ ~~~~_(~ignature of applic~t)