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Home My WebLink About16833-z FOBM NO. It TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne16833 z County Tax Mop No. 1000 Section ........ ~..~... ....... Block ......... Z.~.. ...... Lot No ............. ~ ........ pursuant to application dated ....... ..'~..././.~... .................................... , 19.~.~.., and approved by the Building Inspector. Fee $...~..~ z '~ / B~il'ding Inspector Rev. 6/30780 FOI{M NO. I SURVEY ....... Q',~, TOWN OF SOUTHOLD SEPTIC FORM ~ ' BUILDING DEPARTMENT .............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~/7 ......... 19Y.S Approved i ~..~i '~ ........ 19~. Permit No./.~. ?. .~, .~. . .~ Disapproved a/c .............................. ....... ................................ ..... (B~din~spector) APPh[CATION ~OR BUILDING PERMIT CALL - ............... MAIL TO: P, 0 r ~c~J''~'~' 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 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 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 removal or demolition, as herein described. The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectorS on premises and in building for necessary .......ins~.:~. '}'~'~' · '~ (Signature of applicant, or name, if a corporation) .......[- gre's 'abpiik22;)'7'' ........ State whether applicant is owner, lessee, agent, architect, enginee, ge~al ~on~tor, electrician, plumber or builder. Name of owner of premises ...... ~..~....t~/.g~... ~, .... ]f~.: .ti:..~..~. .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE S.UFFOLK COUNTY LICENSED Builder's License No ....... '.~. ~.-~. {. ? ./~..L ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... . .......... Location of land on which proposed work will be done. .~..t~ House Number Street Hamlet County Tax Map No. 1000 Section ... ~..~. f~. ........ Block ..... ./'..~. ......... Lot .... .G ............ Subdivision .......... 7. ............... .: :: :,-. ..... Eiled Ma.p~0, ,...: ~.~. t :.:~: ...... LoL,~. ............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... fl''-'~'~7' .... ~.~/- .g~..~. · ./~../.~..7 ............................ b. Intended use and occupancy ................. ~..~~ ............................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . 'i ........ Alteration,....., ..... Repair .............. Removal .............. Demolition .............. Other Work..~.,--~,~.:.. i (Description) 4. Estimated Cost ............................ Fee .......... ............................ · (to beipaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................... i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D/mensions of existing structures, if any: Front ............... Rear ...... i ....... Depth ............... Height ............... Number of Stories ........................... I ............................ Dimensions of same structure with alterations or additions: Front ........... 4 ..... Rear .............. Depth ...................... Height ...................... Number of Stories ............. ~ ......... · 8. Dimensions of entire new construction: Front .......... . ..... Rear ....... i ....... 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 construcfion violate any zoning law, ordinance or regulation: ...4 ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address .............. i .... Phone No ................ Name of Architect Address . ! Phone No Name of Contractor .......................... Address .... : ......... i .... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Y~s ..... No ..... *If yes, Southold Town Trustees Permit maybe required. . PLO'r DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. i~dicate 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. APPRGVr, D AS NOTED ., ,, B.P. # .. / l=3 3 '~ ~ NOTIFY"BUILD}'NG 'D~ /g,., ~ ,~ 765-1802' 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,\ 1. FOUNIDATION - TWo REQUIRED "~ FOR POURED CONCRETE %" 2. ROUGH - FRAMING & PLUMBING L - .~3. INSULATION N^Li- C?S UCTION MUST BE COMPl.,TE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REOLIIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. [NOT RESPONSIBLE FOR DESIGN OI CONSTRUCTION STATE OF NEW YORK, ¢OUNTY OF . . . ~ S.S : ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) :' above named. !~e is the , (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 lpplication; that all statements contained in this application are true to the best of hi's knowledge and belief; and that the ~vork will be performed in the manner set forth in the application filed therewith. Sworn to before me this HELEN IL DE VOE N0~RY PI/BLIC, State of New Yor~ (Signature of applicant) . No..4707878, Suffolk County c-c, ~erm Expires Mxrch 30, Ig.~7 ,