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HomeMy WebLinkAbout17050-z FORB~ NO. B 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) 017050 Z at premises located at ....................................................................... County Tax Map No. lO00 Section ....... ./..~...~....., Block ....... ./......~:'... .... Lot No...../..~.........~..../..~ pursuant ,o opplicotion dated ....~.~.../.~...~ .................... 19.~.~, and approved by the Building Inspector. Fee $.,.~ Rev. 6/30/80 DE. .SU~'VI~Y pIZrPAiZ[:D, MAY' D, !97C~ V~N TUYL ~ 50~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... / (Bui~ing Inspector) ',APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... ~ ..... ............... SEPTIC FORM ................ NOTIFY CALL ............ MAIL TO: ~,0-~10 NAY 2 IgsB a. Tiffs 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 l~tyout 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 shail be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shill 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 lluilding 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 iemoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors o ,n~.p{gm. is, es,ap, d in building for necessaw inspections. (Signature at applicant, or name, n a corporauon3 (Mailino address of applicant) State whether appncan[ '~s 9wner, lessee; agaR[, a , engineer, general contractor, electrician, plumber or builder. ..... :'" '"' .................. ~:~t~;~L~;~,' ;/2' '~ .... ; ';' ' ".'~ ........ : ............................. l'qame et owner oi premIs~e,s.~.~yT.~'~,.~,~T5 ,m .................... ,,'~ ................................... ....... *~.e -~z* ............ (as on the tax roll'fir latest deed) If applicant is ~'~rp%l~Tti~i~, s~l~fltt~l~ ~i~lfl~orized officer. ........... ~t~..t[~'I~%.~,..~...~h?~r'~ ...... (Na,h~fl~l~'gt~t~Tfi~Or) 'C Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed'Fork will be_done.~ ............. ' .................................. ' .... ............... ............ e ................. House Number Street Hamlet u County Tax Ma-No. 1000 Section~V, alO____ tT-y. · ./.O. 4 ......... Block..../.'~. ............ Lot. ~..~...~.../.~. ...... Subdivision j~r;~.~..~....~..'...~..~... '..~..t~.: ..... Filed Map No ............... Lot .]. ~.~...~./..7.~... ~"-'~(Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b Intended use and occupancy ~4,Oxc..~, .............. 3. Nature of work (check which aoplicable):, New Building ..... ' ..... Addition .......... Alteratil:kn .......... Repair .............. Removal .............. Demolition ............ Other Work ~ t,r/)'~'' i (Description) 4. Estimate'd Cost ............. ; ....................... Fee ...................................... (to be paid on filing this application) 5. If dwelhng, number of dwellin units .............. Number of dwelling units on each floor ............... l'f garage, number of cars .... ; ............................................................ 6. If busiq~,,.co~nmercial~"r or mixed occupancy specify nature and extent of each tye of use . 7. Dtmen~l~r~s,~fex, ist~ftgstnlctures~afany: Front . . Rear De h He~ghtt~$.F~ ...... ' Nurl~¢~ofStones_H~ ........ ~a~ sln~ctm:~u l~al~eraUons or additions· Front Rear . . l)epth~ ,~ ..~..'~t~'~ IP~I. ~ii~]~bight . '";,;':;_'_"X,;,~". ................ 10. Date of Purchase f...~'".[t.l.~'~.. ......... Cl.. i'.~ir~ ;~Former Owner .~.~.' .~.' i .:~.(5(U./.~.'~.' .~A~.. .... 1 1. Zone or use district in which premises are situated ........................ 12. Does proposed construction vioiate afiy zoning law, ordinance or regulation: ~ ........................... 13. Will lot be regraded .r)l~. .... i ............... /.~O~'*' ~--..~.t.o.e. ....... .... ,Ad, d, ress/gt .O.,.~.~ .Will ex_tess fjJl be removed/9.~.,7. ~fr°m. premises: ' '~'~'~' · '~' '~'Ye's N_o 14. Name Of Owner of premises Name of Architect . .? .......................... aaaress ................... Phone No ................ Name of Contractor Address Phone No Locate clearly and distinctly alll property lines. Give street and blocl interior or comer lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether FOLLOWING INSPECTIONS: I. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PUJMBING BE (~IPLETE FOil C,.O., STATE OF NEW...YO_R.K -- S S COUNTY OF . ...... i' - .......... ~ . li~,v.i. ~ · .~: ~,'/.i..~..~. ........... _ ( ind' 'd a signii,/g contract) above named. ' being duly sworn, deposes and says that he is the applicant N~ Public ...... ~ .... ~,. / H ANN NEVILLE ' ' ' ........ Notary Public, State of Now York ' (~gnature of applicant) No. 52-8125850 Suffolk Term Exp rea O~tober 31, 1 He is the ................... ~. .......................................................... : (Contractor, a~ent, corporate officerl etc:) of said owner or owners, and is dul9 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 filed therewith. Sworn to before me this .......... .... ..... ......