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Home My WebLink About16938-z FORM NO. S TOWN OF $OUTHOLD 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_ Z Dote County Tox Mop No. 1000 Section ........ I./..~ ........ Block ..... .~./...o. ........ Lot No....~....'~...~.. .......... pursuant to application dated ...... ~.~.1~..~ ................... , 19.~..~., and approved by the Building Inspector. Fee $....~..~..~..~ .... Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: Approved. ., Permit No./.~..~..~..~..~. Disapproved a/c ................. : ..... ....... . . . . . .//~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and~u~.bmittecLtg....the~Bgildi~g Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~ ? ~:t~.3~ 9g (ocdlo[l{;l,t;~m~t~t b. mot p~ showing ~ocation of Zot and of build,ss on premi~?~ati~~i~7g[~7~j~es or pubic streets ' ' .... ' ~' '~;~'~ ~ ~' ~" ~ ~'~ his li or areas and giving a detmled description of layout of property mffs~ a~h~a.on2hE'~gra~h ~s pa~ of t app - cation. ~ ~ *~ Uto~ ~t~ ~,~, ~,~ ~'*; c. The work covered by tins apphcatlon may not be commencea'o~[pre lss'uance.~z ~unamg rermzr d. Upon approval of this application, the Building Inspector will ~ss/!ed a~tul~,Pe~it ~9 the O~E~cant. Such pe~i[ shall be kept on the premises available for inspection throu~out the ~ork, . e. No building shall be occupied or used In whole or in p~t for any putpose~hate~er until.a~qrtificate of Occup~cy shall have been granted by the Building Inspector. ,, ,, ~ ,, ~ ~'i ~PLICATION IS HEREBY MADE to the Building Dep~tment~ for the~i~suance of a~ B~lding ~r~it pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable,Laws, Ord~ces or Regulations, for the construction of bulldogs, additions or alterations, or for removal or demolifioff, a~ here~ described. The applicant agrees to comply with all app~cable laws, ordinances, building code, housing code, and regffiations, and to admit authorized inspecto~ on premises and ~ bulldog for necessa~ in's~ections. . ...... . .~.g~ .&.~ ~.~. ¢~.&~.g ~... (Signature of applichnt~e, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....Ti..~ Y~.eP....~.... ~. ~.C¢.9 .... ./:f...'S...24-.. ~ ~¢7 Z~... (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 SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No .................. ..... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............... ,, .................................. · ~' ~ '1' '~ '/ / Hamlet" House Nmnber Street County Tax Map No. i000 Section . ./f..~.'. :'/fl. 7..'~..~.. · Block .................. Lot .'. i ................ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupanc.,y-,of proposed construction: a. Existing use and occupancy . . q~. 8).g .... /. .. ~ .t ............. ~ (~. ................. b. Intended use and occupancy . .~ 3. Nature of work (check which applicable): New Building ' Addition., ......... Alteration .......... Repair .............. Removal .............. Demolition .......... ~ .... Other Work ............... /i (Descrip.tion) 4 Estim tedC Fee ' a ost ..................... : ............................. · (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unfts on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each ty ~e 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 o" Stories --& Dimensions of entire new construction: Front .......... ..... Rear ... i Depth ............... Height ............... Number of Stories ........................... i ............................ 9. Size of lot: Front ...................... Rear ...................... i 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 remov{d from premises: Yes No 14. Name of Owner of premises .................... Address .............. ~ ....Phone No ................ Name of Architect ........................... Address .............. i ....Phone No ................ Name of Contractor .......................... Address .... : ......... J ....Phone No. f ......... 15. Is this property located within 300 feet of a tidal wetland? *Y~s ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, iHdicate 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. APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 7654802 9 AM!TO ,!, PM FOR THE F OLLOWiNG INSPECTIONS. '1. FOUNDATION I ' TVVO REQUIRED FOR POURED CONCRETE 2. ROUGN - FRAMING & PLUMBING 3. INSULATION i 4. FINAL CONSTRUCTION MUBT BE COMPLETE FOR C.G, ALL CONSTRuc/!ION SHALL MEET THE REOUm~EN'rs OS mE N.~. STAT~ CONSTRUCTION & ENERGY COl)ES. NOT RESPONSIBLE FOR Di~SIGN OR CONSi'RUC~ON ERRORS STATE OF NEW Y.OR]L, ,-- . t.. .. ,~ ~OUNTY OF .................. .....~....~..~..o .~.b.... ~f~. ~ . . .///ff../}. 2~..//.(..-'(.' .~.. ! ....... being duly sworn, depo ~es and says that he is the applicant (Name of individual signing contract) above named. He is the 00~Z/~-/2_ (Contractor, agent, corporate officer, el;c:) of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............ ./../ ................ $°tary Public; ~~~i~:~~ County ~---~ ' [~i[~r3'u~ s,~!~,? ~,~ vo~. ?: .. · .. ~..~. of h~s, knowledge and behef; and that the (Signature of applicant)