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HomeMy WebLinkAbout20415-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°- 20415 Z ,o-- at premises located at ..~.?.-...-.~..--~j~....L~ ...................................................................... ........................ ~/~ ................ ~. .................................... ~ .~ ...................................... C~n~ Tax Map No. 1000 ~ctio, .......... ~ .... Bilk ........... ~ ........ ~t No ........ ~.~ ..... application ~t~ .. ~ ............... 19ff~, and pu~uant to ~ ~. ~;.; ................ , app~ ~ ~e Building Insp~tor. ulldin~ns~ctor ' Rev. 6~30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~./~. ........... 1 9 ~.,~ .Approved ..~/~. ........... 19~.. Permit No~.O.~./.'~ .~ Disapproved a/c ..................................... .... .... ............ ..... · / ( B uil~.~ Inspector) ~ 3 I ~[~ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... J SETS OF PLANS .......... SURVEY ................... CIIE£K .................... SEPTIC FORX .............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accur0te 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 ~r *~reas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c: The work covered by this application may not be cbmmenced before issuance of Building Permit· 'd. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail be kept on the premises available for inspection throughout the work. ¢. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. q~e applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary i~pections. ....~,~c.o.. 7..T¢.cIq.. C~..,~.,.-/7~ .c ........ (Signature of applicant, or name, if a corporation) · ~ T. ~;., ~ .~...~oo.d..<c~ .~. ~7.-. ~c:c, ~. (Mailing address of applicant) ,&.9,¥ gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...~o,'lde .r. ......................................................... - ........................ game of owner of premises..~)'J ~).e..~.-/-7....~..('-.(~ (~ ~5. ~)~.~-) ................................... (as oh the t.ax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No../.~.~.T.~..~.~.... ......... Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ~2~....T.<¢.c~...~_~ .< ........... . .~..~..o...4~. o !~ ...................................... llouse Number Street Hamlet County Tax Map No. lOOOSection ..--~..5 .......... Block .... I .............. Lot .... ~....~. ...... '.,. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~5~....C]./'~, :f,.. ~. OO.~/.'/.,:Q.C~ ......................................... b. Intended use and occupancy ..... ,_. ,,~_ _ ~. .......... ; ................................. 3. Nature of work (check which applicable): New Budding .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ...C~.. ........ Other Work ............... 4. Estimated Cost . ~-~) d) ©'O - (Description) 5. lf dwelling, number of dwelling units . .~. . . '(t° be paid on filing this application) ........ Number of dwelling units on each floor .......... . If garage, number of c~ .................................................... 6. If business, commercial or mixed occupancy, specify ature 7. D~mens~ons si ex~shng structures 'f ..... ~., ~/ and extent of each type of use ..... ~.s .................. Number of Stories ...... ' ..... ,ear . ~.. i ........ Depth ...~ .......... D~ensions of Same stmcture with alterations or additions: Front s. .. ........ . ............. ................. ............. t ............. : ........ Number of Stories ........ D~mensmns of entire new constmctxon. Front ............... Rear ............... Depth ............ "' Height ............... Number of Stories 9. Size of lot: Front ' ' ' 10. Date of Purchase ...................... Rear ................................. ...................... Depth .................... I 1. ' ................... ......... Name of Fomer Owner .... ' Zone or use district in which premises are situated ................................. 12. Does proposed Construction violate any zoning law, ordinance or re . . ~.~... 13. Will lot be regraded , gulatmn .... ... 14. N~e of Owner of premises ...... ' ' ' ' ' . ........... ~11 excess ~11 be removed from premises: Yes No Nme of Architect . · ............. Address ................... Phone No. N~e of Con,actor .......................... Address ...... ' ............. .......................... Address ............. Phone No ................ 15. Is this property within 300 feet of a tidal wetland? ~ .......... PhoneNo ................ · If yes, Southold Town Trustees Permit may be requir~[ ..... No ......... · . PLOT DIAG~ Locate clearly ~d distinctly MI build~gs, whe~er existing or proposed, ~d~indicate ~1 set-back d~ensions from7 prope~y ~nes. Give street ~d block nutoner or description accord' interior or comer lot~ ~ ~ ~ ~.. ~-; mg to ~ed, ~ s~ow street nines and red,cate whethor, 1. FOUNDATION ~0 ~EQUIRED FOR POURED CONCRETE 2. ROHGH - FRAMt~G & PLUMBING 3. }NSU~TION 4. FINAL CONSTRUCTION MUST BE COMPL~E FOR C,O. ~ ALL CON8TRU~ION ~HA~ ME~ THE REOUIREMEN~ OF $~AIE CONS~U~ON ~ ENERGY CODES. N~ RESffiNSIB~ FOR DESIGN OR ~U~ON ~RORS T^VE Or NEWX-OR :., OU Vv .... s.s ....... ~ j~}.r~[. ~A-)..... ~.~ .............. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) ~OVe named. 7 ?d. Owner or owners ~d is duly ~ent, Trporate~omcer, etc.) ..................... pncation; that all statements containX'~;~[It~ or pave perished the ~id Work and to m~e ' ork will be perished in the m~ner set forth '- '~Y~52t~'°n-~re }~ue to the best of his ~owled e and bel;,r-~ ~I~. t~s eom to before me this 1., t~,c app~lCfl[IO~ I~led therewith, g .... , ~,u mat the ......... ........ ~taw Public ........ ~' ' ' Sun