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HomeMy WebLinkAbout21120-Z · 0~ 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°-No. 31120Z Permission is hereby granted to: / /'~., ..., / ./~....~..~.~ ...... ~~...~......~;Z~......~~.~~ ........................ ~~~...~~.~ ....... ~.~ ................................................. Co~,nty Tax Mop No. ~000 Section ........ ,..~...~.. ....... ~o~k .~.Z ............... Lot No ...... Z..,,'~'... ......... pursuant to application doted ........ ../'../.../...d~.~.,~... ............................ , 19...~...'~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Approved., ..~.~.~. ........ , 19 .....~.. Permit No. ~../?..,"~?...~ Disapproved a/c ..................................... · (B/Eildino I~:rlSctor) APPLICATION FOR BUILDING PERMIT BOAgD OF HEALI~ ......... 3 SETS oF PLAaS ......... SURVEY .................. ClIE~ ................... SEPTIC FORH .............. CALL HAIL TO: INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se. ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing loc.~tion 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 lhis appli- 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 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 shail 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectozs on premises and in building for necessary inspections· ... J~.l.4a..~3. c.,: 77~..</.. 5 <,.c.,?.eT. ,.&...:~...c_: .... --- .(Signature of applicant, or name, if a corporation) · 15&c:...©.4..~.~R(;.~...~c~'.~:...$~ .c.o.. (Mailing address of applicant) I ~q-/I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Name of owner of premises .... N.~-,...~.'.CiL. ({.q.. I..~.'< .~.t~.M...i:~.,5.q:S¥t .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature o f duly authorized officer· ...° ..... [J (Name and title of corporate officer) · , · ~. Izqqq ~% Builder s License No ........................ Plumber's License No ......................... Other Trade's License No..~..~57..~L)...-~, [{e~T. ~1C~'51G I Location of land on which proposed work will be done -' I . tY. 4 l<~- .,D~t ~.'(-< ...... . ...... o.¢.~..-~..t-O .... House Number Street ~/" Hamlet County Tax Map No. 1000 Section ............... Block Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. E,isting use and o =pancy ..... /)/4'6 ..... . .ttt.t.T. ....... ,.. .......... ,. . b. Intended use and occupancy ................... ~ k.~. 7 ~...~.O. 4./ ............. 3. Nature of work (check which applicable): New Building .......... A.,ddition .......... Alteration .......... Repalr .............. Removal .............. Demolition .............. L,~_. Other Work ............... ~ (Descr/ption) 4. Estimated Cost ....... l .............................. 'Fee '...'~.&,)~. ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ . If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature .and exteht of each type of rise ..................... 7. Dimensions of~existing structures, if any: Front ..... ~7.4.,; ~. ....Rear .... .~.c.,.~ ..... Depth . .~.-.~. ........ He,cbt . ./&. .......... N tuber of Stones ....................... : ................................ Dimensions of same structure with alterations or additions: Front ...... i .......... Rear ............... Depth ......... i ......... Height ..... ............. Number of Stories ........... ; ........... 8. Dimensions of entire new construction: Front ............ Rear ............ Depth ,. 71,. -.~ ....... Height ..... ~ ; ....... Number of Stories ........ : ............................................. 9. Size of lot: Front ....... ~;?.q?..:~.. .... '. Rear .... ..5'~/. < ./. [ ........ ;.. Depth . .'~'.~:~... ~. '.~. ......... I0. Date of Purchase .................... - ......... Name of Former Owner ............................. I I. Zone or use district in which premises are situated.. ~'f~../.~.~..'.bt',r.~Eqx(- .??~ ............................... 12. Does proposed construct~o~n violate any zoning law, ordinance or regulation: ....~./..d ......................... 13. Will lot be regraded.,.."/.. ....... ................ Will excess fill be removed from premises: Yes /'<L No 14. Name of Owner of premises ~..~q~..~'~q~.~.'¥'~ .'~:.~(. Address ?~-:~?.~../.z.~.~..~.~4~.~.. Phone No ................ · Name of Architect ........................... Address ............. Name of Contractor ~/~VC~...~¢7:'~7~,q'.'. ~.u.*.o?~..;~.~..:<_ Address/.~. Is this property within 300 feet of a tidal wetland? ~Ye~.. No ......... *If yes, Sou'thold 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 coruer lot. t5. APPROt/, D AS NOTED 765-1802 ~ AM TO 4 PM FOR THE FOLEOWI~G INGP~CT~ONS; FOil POURED CONCRETE 2. ROUGH FRAMING & PLUMBI~G 3 INSLJLfl~ION 4 FINAL CO[~STRUCTION MUST 6E COMPLETE FOR C,O. AL[ CONSTRUCTION SHALL ME~ THE REOUIREMENT~ OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR ~NS~U~ON ERRORS ~T~A. TE OF NEW YORK~ ~- ~OUNT¥ OF.,..~ r.24.,., .,¢?~.¢.[:( .<...., S.S ......... .~f, ~//~..~/~/~ ?~-rz~2. ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~bove named. {e is the....~. ¢~..~.~./.~.~-~.'~ ......................................................................... (Contractor, agent, corporate officer, etc.) . ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this :pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in thc manner set forth in the application filed therewith. ;worn to before reed this .......... ....... day or .... Notary Public, State of Now ¥o1~ ' (Signatur~ o~ appdcanrl No. 4951364 Oualified in Sutfo k County Commission Expires May 22. 19