The URL can be used to link to this page

Home My WebLink About19589-ZTOWN 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) N~ 19589 Z Permission is hereby granted to: ,o ................. ?~,.~'i~'"i ....................................... ~ .......... ~ .............. ~ ................................. '-' ....................... t p 'SS ~at~at ..... ~ ............ ~.~ ........ County Tax Mop No. 1000 Section ..... ..~...~...~.. ..... Block ..... ..~....[ .......Lot No......(~...~. ............. pursuant to application dat~.....~ ....... ~....~. ......... , 19.~..0..., and approved by the Building Inspector. Building I nsl:mctor Rev. 6/30/80 Approved---~1~.~ C,.,~..[a'~%.. fr.., 19C~0. Permit No ............ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... -' (BmTdin'gqnspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: Date ................... 19... INSTRUCTIONS a. This 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 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 this appli- cation. 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 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 any 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, Ordinances 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 inspectors on premises and in building for necessa ,ry i~?ecti0~ns_. ~) , ^ ) (Signature of applicant, or name, if a corporation) ?. . . . . . . . . . . . ..... (Mailing address of appticart't) State ~t is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. ...... .................................................................. Name o~f owner'~of premises. J.(~Z[/.qfk~ .... )."¥[t~. ~) ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. l~louse' ~'/'u~l};r.,~ C,~(~ . . . ('--~-'.(,k..~. ,:[ .1...~ld4J.-, . .Street '~J~' '~' '~ County Tax Map No. 1000 Section ..... 9.~. ........ Block ..... I ............. Lot .... ?]'. ........... Subdivision ..................................... Filed 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 Building .......... A. dd,/tion... ~'~..~1 '' Rep .............. Removal .............. Demolition ..?. ........ 4. Estimated Cost ...................................... Fee (to be p~d on filing thi[~p~}~J*~) ' ' 5. If dwelling, number of dwelling units ............... Number of dwelling umts on..~[~ea ~0~,, ~..0. ~ ..-~'~O"'- [~_ - · . If garage, number of cra ........................................................................ 6. If business, commercial or mixed occup~cy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... HeiSt ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth ....... ' HeiSt ...................... Number of Stories ...................... 8. Dimensionsofentirenewconstmction: Front ............... Rear ............... Depth ............... HeiSt ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Foyer Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. W~I lot be regraded .................. Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises .................... Address ................... Phone No ................ Nme of Architect ........................... Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No ................ Is th~s property wSchSn 300 feet of a tSdal wetland? ~Yes ........ ~o ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAG~M Locate clearly ~d distinctly ~1 burden, whe~er exist~g or proposed, ~d. indicate fll set-back d~ensions from propeRy ~nes. Give street and block number or description accorded to deed, and show st~et nines and indicate whether ~tefior or corner lot. APPROVED AS NOTED DAT~: -~ rL.~).Z.g/~ZB.~ # / ?,S'-~ ,5. NOTIFY BUILDING D£PA~T~ENT FOLLOWING INSPECTIONS 1. ~OUNDATIO~ IWO ~[QUI~EO 2. ROUS"- FRAMING & PLUMBINO 4 [,~,L co~s*.UCT~O~ Mus~ 8E COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y~ STATE CONS~UCTION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named~.~ ~,~ .tl.) He is the ................... ~) ..- ' (Contractor corporate o'ffl~e;, e of said owner or owners, and is duly authorized to perform or have performed the said work 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 performed in the manner set forth in the application filed therewith. Sworn to before me this .............. /.¢. ....... day of... ~..? ............. , ~9 ~.. Notary Public, .,. ~q< '.~,-.~-J~ County .................., HEIfN K. ~ V0E NOTARY PU BMC, St~lt of I~lw Yotll ....................... No. 4707878, ~uffo~k I~ltt~. ' ' (Signature of applicant)