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Home My WebLink About16899-z ]FOWM NO. ,u 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) NO 1 61~99 Z Date ..... .~..........~:.....~.. ............ Permission is hereby granted to: "~'~~'"~',~:""7 ...~.~~ ....... ..v.... i'~.~'i"' ~o ..~~......~... ~..~.. ~.~ ...... ~... ~~...~ · .~ .... f~ .............. ~...; .~.....~-~ ............................................................................... · ~...~~~~.....~..~.~. ~.~ ............................................ cou.~ Tox Mop No ~000 Sec,,7~;~... ~.. B,~k ....~. .......... Lo, No .~...7. ...... pursuant to opphcatlon dated ~.,~-.,~.. ~.:~ ....... 19~.., and approved by tlne Building Inspector. Fee $..~.:..~... Rev 6/30/80 FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC '[JOWN H/~LL $OU'F~LD N.~'f 11971 NOTIFY APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. CALL ................ MAIL TO: ok INSTRUCTIONS a. Tbas apphcatlon must be completely filled in by typewnter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public stree or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this app cahon. c. The work covered by ttus apphcatlon may not be commenced before issuance of Building Permit d. Upon approval of this application, the Bmldlng Inspector will issued a Building Permit to the apphcant Such perm sh~ll be kept on the premmes available for mspeebon throughout the work e. No burldmg shall be occupied or used In whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the msuance of a Bmldmg Permit pursuant to tl Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construchon of bmldmgs, additions or alterations, or for removal or demohtlon, as hereto describe, The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulatmns, and admit authorized inspectors on premises and m budding for necessary Inspeqt~ons ? (Signature of applicant, or name, if a corporation) (Mailing address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde, Name of owner of premmes (as on the tax roll or latest deed) If applicant is a corporation, signature of duly author]zed officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... Plumber's License No Electrician's License No Other Trade s License No ......... Location of land on which proposed work will be done 2,595 House Num her Street APPROVED AS NOTED DA E NOTIFY BUILDING DEPARTMENT AT 765 ~802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS ] FOUNDATION ~O REQUtRED FOR POURED CONCRETE 2ROUGH - ~AMING & PLUMBING 3INSU~TION 4 FINAl. CONSTRUCTION MUST ..... -.-- ~'~~ONS~U~ON S"~ ME~ STA~~ & ~ERGY CODES. County Tax Map NO I000 Section k"s-,/ Block ~ DESIGN OR. ~gON,~l~l~lJ~Ol~ ERROR~- Subd,,,s,on Filed Map No Lot ~ ~ (kame) State existing use and occupancy of premises ~ intended use and occupancy of proposed con--n, 3. Nature of work (check which applicable) New Budding 4 5. Add~tmn ,.. Alteranon ·. Demolmon Other Work ~ .... (pescnplion) ........... Fee ~f~ , .... ~ .2 ............ ' (to be prod on filing tins apphcatIon) ....... Number of dwelhng units on each floor ......... Repair .... Removal Estimated Cost-~/ .2. If dwelling, number of dwelhng umts .. If garage, number of cars .................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use Dlmensmns of existing structures, if any Front .. Rear ....... Depth ......... Height .. Number of Stones ............... Dm~ensmns of same structure with alterations or additions Front ......... Rear ........ Depth ...... Height ........... Number of Stones 8. Dm~enslons 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 1 1· Zone or use district tn which premises are situated 12 Does proposed construction wolate any zomng law, ordinance or regulation .................... 13. Wall lot be regraded ............. Will excess flI1 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 .......... Phone No .... 15. Is this property located withzn 300 feet of a tidal wetland? *Yes ..... No ..... mil yes, Southold Town Trustees Permit maybe required. PLOT DIAGKAM Locate clearly and dmtmctly all bu,ldmgs, whether ex~stmg or proposed, and indicate all set-back d~mens~ons from property hnes G~ve street and block number or description accordmg to deed, and show street names and mdmate whether interior or comer lot STATE OF NEW YORK, COUNTY OF ..... S S ..... being duly sworn, deposes and says that he ~s the apphcant (S~gnature of applicant) (Name of ~ndlvldual signing contract) above named. He ~s the /q (Contractor, agent, corporate officer, etc ) of said owner or ow~ners, and m d~41y authorized to perform or have performed the smd work and to make and file tins apphcatlon, .Cat alt st;at, ements contained in tins apphcat~on are true to the best of Ins knowledge and belief, and that the work wtll be~ performed ~n the manner set forth m the application filed therewith. Sworn to, before me this ~ ........ d.4 ....... day of.. . ........ 19 .~'-. Notary Pubhc, ...~.......~.'..~..,~f