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HomeMy WebLinkAbout19865-ZTOWN 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~- 19865 Z Permission is hereby granted to: .. ~.~... '~_..~~..~ ....... ,o...../...~~.../_~......~_,~...~ ...... ~ ....... ~~ ot premises located at ..... ~,..~.,.,.,~,,~~/~ ................................................ County Tax Map No. 1000 Section ......... ..~...~. ...... Block .......... ~ ..... Lot No .......... ~.. ......... pursuant to application dated .............~>-~/-././...~.. ................................. , 19.~./.., and approved by the Building Inspector. Fee $....~.~..~...~ Rev. 6/30/80 xamined MAY I 4 991 197/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-11J02 isapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ......... , 19 a. Tlfis application must be completely filled in by Wpewriter or in ink and snbmitted to thc Building Inspector, with 3 s'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 areas, and giving a detailed description of layout of property must b~ drawn on the diagram which is part of this appli- ion. c. The work covered by tkis application may not be c'bmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wUI issued a Building Permit to the appl/cant. Such permit !I 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 11 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perr~it pfirsuant to the Iding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appl/cc~e, Ldws, Ordinances or :ulations, for the constr~ction of bu;ldings, additions or alterations, or for remova~ d,q:t't~._olition, as hereto described. : applicant agrees, to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lit autt~or/zefl inspectom on premises and in building for necessary iZ~bections, r~ ~ /"'h ! ,, ,. (Mailing address of ~ppllcar/t) te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ......... (as on the t~: roll or latest deed(l// -~ ' ¢' ;~plicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) Builder s L~cense No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... .ocat'ono,a donwh,chpro .osed, ork ilX edm,e. ....... ..... .... ................... ............... ................ ounty Tax Map No. 1000 Section . ~ .............. Block . .~.~. ............ Lot ................... ~bdivision ..................................... Filed Map No ............... Lot ............... (Name) ate existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .... . · .,.. ,.. .......... ~.' ...... .. ............. Intended use and occupancy ..... , · J. ..... ~,,,.c~ ~;~ ~'~' ........ 3. Nature o! work (check ~h~ch apphcahlc)yNew Building .......... Ad~ffmn ........... \Iteration .......... Repair .............. Removal q~. ...... .. Demolition .q.-:C. ........... Other \W)rk~ .; ............ (Description) 4. Estimated Cost ...................................... Fee ...................................... (to be paid (m filing this application) 5. If dwelling, number of dwellin-_~its .............. Nu nberofdwe bng units on each floor ................ . If garage, number of ears .. ~_~~.. i ..................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nmnber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Hell:hr Nmuber of Stones 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... O. Date of Purchase ............................. Name of Former Owner ............................. I. Zone or use district in which premises are situated ............................. .......... .............. ~ Does proposed construction violate any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded ............................ Will excess fill be removed from premises: Yes .. No 4. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 5. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether e. xisting 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 ~terior or comer lot. I APiOV, ED AS NO'I kD /' / __ t. FO~D~iON - ~O REQUIRED FOR~O~RED CONCRETE 3, ~NSU~Ti [ FRAMING & PLUMBING ON ,4,. ~:IN~L 4 CONSTflUCTIONMUST BE ClOI~LETE FOR ALL C~N~RUCTION SHALL MEET THE RI[.Q~,~I~EMENTS OF ~ N.Y. STATE ~b'~TRUCTION & ENERGY CODES.[ 'N~I" RESI~ON~IBI.~ FOR DESIGN~ONSTRIJCTION_ ERRORS ~TE OF NEW YOJIK,*- , , S.S ~,m'¥ oF ..... .~..\.~)~ .... (Name of individual signing contract) named. bcing duly sworn, deposes and says that ho is thc applicant : the ....................... . .O~...~...i .......................................................... (Contractor, agent, corporate officer, etc.) .id Owner or owners, and is duly authorized to perform or bare performed the said work and to make and file this cation; that all statements contained in this application arc true to the best of his knowledge and belief; and that the will be performed in the manner set forth in the application filed therewith. n to before mc this - .................... ~;~,../...&fl. ........... 19.,. . ' ..... ......... .:_ ...... ....