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Home My WebLink About19383-Z I~ORBS NO. · TOWN 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°- 93a~, Z Permission is hereby granted to: ~.. -- / ~ ~ --' ~"'hT,";'"_""'";"."'-'"""'"'"_'_ , , . ., r.~,,., ,~.,.. .,, '. .... ~ ........... --~.~/...~....,.2~. ................................................ County Tax Map No. 1000 Section ..~-7..- ........ Block .......~... ............ Lot No. /(~ pursuant tO application dated ...... .~.../.~.... ................................ , 19..~....,~ and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOI~D BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 7G5-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ....... CHECK ...................... SEPTIC FORH ................ Examined · ^pprovcd ........ lP~c~it No... Disapproved Mc ..................................... APPLICATION FOR BUILDING PERMIT CALL ......... MAIL TO: II Ill--'''''~ ............... ', !~ BLDG. DEPT· TOWN.~F/S~UTHOLD Date.. .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Ifispector, with 3 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 part of th.is appli- cation. a. 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 bc kept on the premises available for inspection throughout the work. e. No buildMg shall be occupied or used'in whole or in part for at)y purp*ose whatever until a Certificate of Occupancy 'shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to thc Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Thc applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary' inspections. (Signature of applicant, or name, if a corporatxon) - (Mailing address of applicant) State wh~ther appl'ic~ni' is' Owner, lessee, a~ent, architect, engineer, general contractor, electrician, plumber or builder. If applica~il~ is a corporation, s~:l,ature of duly authorized officer. (i%me [pd ~ otScO~,orate ~Officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work ~vill be done: -. House Number Street, Hatnlet · County Tax Map No. 1000 Section BlOck Lot. . . Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) 2. Slate existing use and occupancy of premises and intended use and occupancy of proposed constrnction: a. Existing use and occupancy ......................................... B. Intended use and occupancy ............................... ~'~'e Repair .... ~ .... Rffmoval ........ .~..... Demolit on . . S~i,,'nraing pool Tennis Courff--- ......... Accesser Bu .... ' ......... '''' ...... y :tJ_azng .......... Fence ....... Other Work;... 4. Estimated Cost Fee 5. / (to be paid on filing this application} If dwelling, number of dwelling units ............... Number of dwelling units on each floor .... ' .. Ir garaee, number or cars ............................................................ 6. If business, commercial or mixed occupancy, specify llature and extent of each type of use .............. 7. Dimensions of, existing structures, if any: Front.. ~.~.~. ....... Rear :~o~'.. ....... Depth .~.,,.'i. '' Height ./.~. .......... Number of Stories...~.~ ..... ' ........ ' '~' Dimensions of same structure with alterations or add.t.ons: Front ...~.'.~.ii.iii.ii. Rear.~'~.. ........ : Depth ...... ,~. ............. Height ...~.y.r ................ Number of Stories... ~ ...... ' ........ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... er of Stories .... ,j ~" ' T i~5' ' ' ......... 9' Size °f l°t: Pr°at "~ "! i:: ' N?~m(~ ' ': :l 5~" ' ........... Rea. ........ 222 1222252222225522 lO. DateofPurchase ............................ ,,N.~ame of Former Owner ............................. 11. Zone or use district in which premises are situated J(,~.~ ~.. ~ ./.5'/~..t~ ' 1,.. Do s prop~,osed constructmn vkolate any zonmg law, ordnance or regulation: ................................. }3.. }V, ilI lot ?~regraded ..... 't~' 'O~'a :,'cs --./-.. :>-~'.'~:.. Will excess fill be removed from ¢remises: t,~. 2ame o~_ Owner of pre.mises~ .q.d~l~..~.t.~.? .... '~.~,~ddress . ~/J..~. ~.. gt~.l~fmne No..~2.~..g.~.7.~..~ :' ~ame otArchitect ~.l/.t//..~..?~: .~...~0u../Tl~..Address .M0{ptu.&.~..~./4~ Phone No ."~-~'..~-~ .~.~--~-. ' Name of Contractor .~"'~[C'~. l~Ojt,~(~-~.~... Addres~ '7 t_c V ' 15.Is this property lo' eate~l'~ithin"~OO leer'o'}; t""''i~l;'l"~:'l.'~nd"~"~"~.'S'.'..2~.lq~-~b':.'.'~ .... ~If yes, $outhold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED DATE: ' B.R # , FEE: BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1.FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2.ROUGH - FRAMING & PLUMBING 3.INSULATION 4.FINAL CONSTRUCTION MU~T BE COMPLETE FOR C.O. ALL CONSTRUCTION ~HALL MEET THE REQUIREMENT~ OF ~IE N.Y. STATE CONSTRUCTIO~ & ENERGY CODES. NOT R~$PONhlhL~ FOR DESIGN OR CONSTffiJCIIO~ EhRO~S STATE OF N~V,~.ORI~-" ,f I~ S y oF....%-.-o. 3.q &_ s. ' ' '/~ ~' '/~,;~' :7~:c'ff' ' ' '; ' '7~)~/' '~'''~'c- ''~' · · - being dt, ly sworn, deposes and says that he is the applicant (Name o~ inaiviuua signing contract) .... above named. H-e is the ' of said owner or owners, and is duly authorized to pe,rform or have performed the said xvork and to make 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 will be perforated in the manner set forth in the applicatiou filed therewith. Sworn to before me this · , ............ L~..: ..... ~ay of.:...~ ........ 19..~. C~ ~ ~ ~%W~~ ~--~ -- q/) ~ ' (Signature of applic~t)