The URL can be used to link to this page

Home My WebLink About19222-Z FO~M NO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- Z Permission is hereby granted to: ' ........... County Tax Map No. 1000 Section .,./.....'~'.,.?. .......... Block .... ...~..(, ......... Lot No....~..:....~, .......... pursuant to application doted ...... ...,~..~.........~...~ ............... , 19.c~.~,, and approved by the Building Inspector. ;*;'?'"'""'""Bu-~l'ding Inspector Rev. 6/30/80 II--IH BLDG. DEPT. TOWN OF,$OUTHOLD Approved . .'~..~.., 19 .~.~. Permit No. ~.' .~..~. ,'~..?~..~. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD. N.Y, 11971 TEL.: 765-1802 BOARD OF HEALYH ............ 3 SETS OF PLANS ............ SURVEY ........ ~ ............ CHECK ...................... SEPTIC FORH ................ CALL .............. MAIL TO: Disapproved a/c ..................................... ........................ (Building Inspector) APPLICATION FOR BtM LDING PERM IT INSTRUCTIONS a. Tiffs ap~licaiion must be completely filled in by typewriter or in ink and submitted to the Building lhspector, with 3 ::: of plans, accurate plot plan tO'~cal¢. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ; ,~reas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 :i', Se kept on the premises available for inspection throughout the work. .:. No building shall be occupied or used in whole or in part for at3y purpose whatever until a Certificate of Occupancy :.: !:ave been granted by the Building Inspector. '.f'PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the . ,!:?. Zone Ordinance of the Town of S~uthold, Suffolk County, New York, and other appIicabl¢ Laws, Ordinances ox :.;::OHS, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. , :'?iicant agrees to comply with all applicable laws, ordinances, building code, housifl~ co~d~uJation, s; and to ~ :: :.uthorized inspectors on premises and in building for nece~ssa..ry inspections. /. ~(_..~r.e.~.~. ~ ~t,D . (Signature o~ applicant, or naM/e, if a corporation) (Mailing address of applicant) :~ ::ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as oil/the tax roll orHfitest deed) .:ar i~ a corporati~.sign, ature of duly authorize~_~ officer, (Name and title of co.orate officer) · ..::nber s License No. "*?:er Trade's License No :ca~ion of land on which proposed work will be done: ~ ~ :~.~ ,5' ,5 -- ~ ' : ~ usc Number Street. ' Hamlet ",~mty Tax Map No. I000 S~ction . : ...... Block ................. Lot.. .' ......... .. ,~. l'::bdivision Eilcd Map No Lot (Name) qt~te existing use and occupancy of premises and intended use and Occupancy of proposed construction: A. .............. : ............ ,', ........ g, Intended use and occupancy..,~ ...... ~ .......................... --. Nature'ofwork(checkwhichapplicable}: New Building ~" Addition / Alteranon ;-,.,.,i..,~,~. Repair .............. gl~moval .............. Demolition .............. Swimming pool... Tennis Court ~ ........ Accessory Building .......... Fence ....... Other ~.. E~timated Co~t ~ ~· ~ ~ Fee (to be paid on filing thi~ application} If dx%'elting number of dwelling units Number o f dwetling units on each floor If gara=e, number of cars If bu~iseas, commercial or mixed occupancy, ~peci{'y nature and extent of each type of_use . .~.~.~ ........ Dimensions of existing structures if any: Front...~ ~ ..... Rear . .~ ~. Depth ~. t{eieht ~. ~ Number of Stories ~ ~ ' Dimensions ofxame st~clure with alterations or additions: Front ................. Rear .................. De,th ...................... HeiSt ...................... Number of Stohes ...................... Dimensions of entire new constn~ction: Front ............... Rear ............... DeDth ............... Height ............... ~umber of Stories .............. ; .......................................... Size of lot: Front ............ R a ....................... Depth ..... Date ofrurcha:e ,Aegg ................ Name of Fomer Owner W~&~. ~:~ .... Zone or u~e district in which premises are situated... ~(C~.6 TMff~ ~ ................................ Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................ ~,'at lot be regraded ....... ~ .................. Will excess fill he removes f~pm~misex: Yes .,~e of Owner of premises .. ~ l~d~.k¢.~.. .... Address q~ ~.$Vfff.!~e~ ~fie No. X Pg.z ~: ~ ~.~. 7:~e of Architect ...... Address . . Phone No. .,~e of Contractor ~ .......... Address ............ O ..... Phone No .......... :~ this property located ~ithln 300 feet of a tidal ~etland? *YES .... ~tf yes, Southold Toan ~rustees Per, it say be required. PLOT DIAG~M Locate cle~ly =d distMctly.Ml bufldMgs, whether existing or proposed, ~d. indicate fll set-back d~ensions from ~rW fines. Give street ~d block number or description accordMg to deed, ~d show street n~es ~d ~dicate whether ::~r or corner lot. APPROVED AS NOTED DATE: ~ ~-~B.R # ~ ~'~-.~'~-~ NOTIfy BUILDING DEPARTMENT AT 765 1802 9 AM TO 4 PM FOR THE I gOUNDAT~Ot~ T~O REQUIRED FOR POuR[D CONCRETE 2 RO~}GH FRAMING & PLUMBING 4 FIN;xL CONSTRUCTION MUST BE COMPLETE FOR CO ALL CONSTRUCTION ~ALL MEET THE R~OUIREMEN~S OF ~E N,~ S~.~T~ CONSTRUCTION & ENERGY OES/GN OR CONSTRUCTION ERRORS "")F NEXV YORK, ', 7'*' OF ........ S.S .............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) (Contractor, agent , corporate officer, ctc. owner or owners, and is duly authorized to pc,rform or have performed thc said work and to make and file this . 2::on: that all statements contained in this application are true to the best of his knowledge and belief;and that the ','viii be perl'om~ed in thc m~ner set forth in rite application filed therewith. to before me this ..... day Of .... ~ .......... , 19 P~bl c ............ County ~ ~ ~ ~ ~ (Signature of applic~t)