The URL can be used to link to this page

Home My WebLink About19888-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 19888 Z Permission is hereby granted to: _ .............. .L..~..~.~......~.....~ .................. (~.~ .......... :..~., ............ ., ............................ ,o ..... at premises located at ..~..?...~....~......~......~......~.~.: ................................. County Tax Mop No. I000 Section ..... ..o.....~.....~. ....... Block ...... ..~.....'~.. ..... Lot No....~....~...:..~.. ....... pursuant to application dated ....... ~......~......~...[..~. ................... ,19...~.~.., and approved by the Building Inspector. .... ~Building-ln.q:mctor Rev. 6~30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHCiLFL ~¥. 1.t~7 !. TEL.: 765-1802 APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ........... 3 SETS OF PLANS .... ; ...... SEPTIC ;ORH ...... CALL '~ MAIL TO: Date ............ I9 INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted to the Building l}~apjtor, with ~ets of pin.% ~-'-rat¢ plot plan to scale· Fc~ acc~rdring to schedule. b. Plot plan showing location of lot and Of buildings on premises, relationship to adjoining premises or public street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is par~ of this appl5 · cation. o. 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 permfl shall be kept on the premises available for inspection throughout the work. e. No building shall !?,c occupic, d ,or. u~ed in. whole or in part for a.ny purpose whatever until a Certificate of Occupancy shall have been granted ,by the Building Inspect, or. APPLICATION IS HEREBY' MADE t°. the Buil~iing Department for the issuance of a Building Permit pursuant to thc Building Zone Ordinance~ of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulatioml, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. TIi¢ applicant agreea to comply with all applicable laws, ordinances, building~code, housing cod~and regulations, and to (Signature et applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant i~ Owner, lessee, agent, architect, engineer, general contracto~llql~0~l~l~l}~rl~r or builder. ow,, ........ (as on thc tax roll or la~ 9 AM D 4 P~ ~u. - ' FOLLOWING INSPECTIONS: ~[ applicant is a ¢o~po~tion, signature o~ duJy authorized of~cer. 1. FDUNDATtON ~O REQUIRED · FOR POURED CONCRETE 2. ROUGH - FRAMING'& PLUMBING Builder's License No Plumber's License No ......................... Electrician's License No .......... .. ............ Other Tradc's License No ...................... 3. INSULATION FINAL CONSTRUCTION MUST BE cOMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR. CONSTRUCTION ERRORS 1. Location of land on which proposed work will bc done; llouse Number Street. ' ' Hmnlet ....... ....... County Tax MapNo. I O00Section .. .. .~ ,; . Subdivision ..................................... Riled Map No ............... Lot ............... (Name) !. St~tc existing usc and occupancy of prcmi~c~ and intended use and occupancy of proposed construction: A. Existing use and occupancy ............ ~~..[ .............. ;--j ...... ..... B. lntended use and occupancy ........ ~ ........... 3. Naturc of work (check which applicable): Ncxv Building .......... Additiop .......... Alteration ......... '. Rep-,ir ........ ~,, ~... R~moval_ .............. Demolition ~'~/-~. ...... Swimming pool ............. Tennis Court ......... accessory Build~ng---- .......... Fence ....... OCher Work: ........... 4 Estimated Cost Fee [?.', ' ~ he paid on filing this a~plication~ 5 Ifd elli b fd Iii it ...... N fd Iii ,nit h fl ............ , w ne, sum er o we ng un s ......... umber o we ng u s on eec oor.. . .. If garage number of cars. . -- · ,.--.,--. ..... ' ......... 6. If business, commercial or mixed occupancy, specify nature and extent of each typc of use ...................... 7 Dimensions of existing structures if any: Front Rear ' Depth Height ............... Number of Stories ......................... i .................... ~i'~'i'' ' Dimensions of same structure with alterations or additions: Front .............. Rear ........ Depth Height Number of Stories ............... Dimensions of entire new construction: Front ' Rear Depth Height Number of Stories ' 9 Sizeoflot:Fi-ont. . Rear . .. ........... Depth ................. · 10 Date of Purchase Name of Former Owner · · · 1 1 Zone or use district in which premises are situated ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...........- ....... · -.------- · - !3. Will lot be ret.reded ............................ Will excess fill be removed from prerabea: . Yea .... Nn 14 Name of Owner of premia~ j' Address . . Phone No ............ .-- Name of Architect Address . . Phone No.......-. ..... · Name of Contractor ' Address Phone No . l.%_l.a ~.~.ia property located wlt~hin'ao0 feet of a .tidal wetland? *YES .... NO .... · 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 d~scription according to deed, and show stree~ names and indicate whether interior or comer lot. ' STATE OF NE%V YORK, S.S (Name olJindivid.ual ~i?_ming contract) above named. H~ is the ........................................... : .......................................... .'. (Contractor, agent, corporate officer, ctc.) of said owner or owners, and is duly authorized to pc,florin or havo performed thc said work and to make and file thi application; that all statements contained in tiffs application are true to thc best of his knowledge and belief; and that th~ work will be perforated in the manner set forth in thc applicatiou filed th~:rcwiglt~,~ ~ ~ c this . . r,~: 7:: ';ork Sworn to b~:t'o[~c ~ 3~,~~vu' ' ~-.- da' of .... lV.5'.l v : · ;'' ............ I.I .... ,~. .... Y ........ b ....... , ' ' {~B'F - 'i ~', :~1'~ Nots , ' ~ ~ ................ ~ ..C ny ~ ~ ~ . ou t~ Pubhc, (Signature of applicant