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Home My WebLink About23152-ZFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N? 23152 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...~~ ....... .~~..././~... ................. ..... ~,c~... ........ .~..~.~. ....... ~....~ ................. ~ ....... L.~.~.~.~ ............... .:..~,~ ...................... to ...... ~.~...6..~ ....... ~. ........... ~.~,.-.F... ....... ~,i.....~<~.~ .................... CoLlnlyTax Mop No. 1000 Seotiorl ...... ~;)~ ............ Block ........ ..~...~._ ........ Lot No ..... ,.~. ,.~,. ................ pursuant to application dated ............................ 19 ......... and approved by the Building Inspector. ~ee ~..~:..~ ...... Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... ..... 19 ^pproYed ..... 4 ,/Z ..... ? . Permit No. Disapproved ale ..................................... BOAKD OF It~ALIit 3 SETS OF PLAINS SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ...... ...... ¢ ... F.-. ... APPLICATION FOR BUILDING PERMIT 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 Pennit 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 rem~oval or dem~ition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cji, ho~_usij~2~de, and regulations, and to admit authorized inspectors op premises and hl building for necessary inspectio~/f j¢'~/? ,./_. (Si~fft~re o~alYplicant,pr name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpre,nises. .~.4.f.~.c'...t~....~..:..~4~..e.¢.8. e./.( APPROV£D AS NOTED (as on tile tax roll or If applicant is a corporation, signature of duly authorized officer. FEE:~' ''~7' ~ BY: NOTIFY BUILDING OEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Builder's License No .......................... 2. ROUGH - FRAMING & PLUMBING 3. INSlJLATION Plumber's License No ......................... 4, FINAL - CONSTRUCTION MUST SE COMPLETE FOR C.O. Electrician's License No ....................... ALL CONSTfluC~toN ~HALL MEET - , THE REQUIREMENTS OF THE N.Y. Other Trade's License No ...................... ' ' ' · GTATE C~I~STRucTION & ENERGY ,/,.-. ,/'- /' ,~/ CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done...t'~.°f..~.....~...~.~/..~..~.. [ .~...~...~..~.1.8,~..G~.0.N. House Number Street ~ Hamlet County Tax Map No. 1000 Section .... .~..e~.~. ........ Block .... ;,:'.~.. .......... Lot..../ ............... Snbdivision ..................................... Filed Map No'. . ~ ............ Lot ............... (Nmne) 2. State existing use and occupancy of premises and i~ttended us~ and 6ecupancy.of proposed construction: 3. Nature of work (check which applicable): New Building ~ .... Addition .......... Alteration .......... Repair · ~ --"-~ (Description) 4. Estimated Cost ...................................... 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 extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .................. .~P..ho. ne No ................ Is this property within 300 feet of a tidal wetland? *Yes ..... ,(~No..). *If yes, Southold Town Trustees Permit may be requ~red[ ' ~ ...... 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 corner lot. 15. STATE OF NEW ~'ORK- ~. COUNTY OF.. ~ 17t~ t'- t S.S ........ ..... ...'. '.'fP'.~.~.". '...~.~ ~...C..~.../.~( .77]... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) He is the __, .~t~ ~- 6~JL] e (Contractor, agent, corporate officer, etc.) 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 flied therewith. Sworn to before me this ~ ........................ day of...~.~.e.~.~q.../~. · .4~.~ ..... 19 ?. J. /7 ' ' ' ~IBBON$