The URL can be used to link to this page

Home My WebLink About16981-z FO~ NO. ~ 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) N~1698t Z Permission is hereby granted to: ~~...~ ........... ~ .......................... ~ ........ ~ ...... ./../..../.~ ................ : ........................................... Coun~ Tax Mop No: 1000 Section ...... Z.~ ..... Bilk ......... .~. ......Lot No ........... ~.~.. Building Inspector. Fee $,~..~ ,.,~, Rev. 6/30,/~0 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved ·..~./..3 .......... 19~.~. Permit No..//.~7 ....... Disapproved a/c ..................................... (,g uildin ~}fi specto r ) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY MAIL TO:~ BLDG DE~ TOWN OF D INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the .Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whioh is part of this appli- cation. c. The work covered by this application may not be commenced before issu,ance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building. permit to the applicant. Such permit shah be kept on the premises available for inspection throughout the work. e. No' building shall be occupied or used in whole or in part for any P?pg~e:wh~tever until a Certificate of Occupancy shall je;a've been granted by the Building Inspector. ~ ~ ,~. ~ L~ ~ ' :; APPLICATION IS HEREBY MADE to the Building Department for the i~'~'6f a B~ilding P;~it' ~ursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~Y0r~; and o~ther apl~licable~Laws~ Ordinances or Regulations, for the construction of buildings, additions or alterations, O~f$~ f~oi~!~or¢ dem0!iti6h~ as h~rein described. The applicant agrees to comply with all applicable laws, ordinances, bfiil&riff c6d~;, 'h~hsing code, and ~regi]lat3ons, and to admit authorized inspectors on premises and in building for necessary inspe~ti~s.. (Signature of appli~h//t/Or flame, if a e'ol:poration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises /4q~4~ d~'/-A~ /'~O~Je;~ d~/ I~' (as on the tax roil 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 ...................... Location of land on which proposed work will be done] ................................................. ~ Y' ~'" /"t"l,~,~ t~ ~t & L ~ . /~ ~i r r , r ~ ¢ .~ . . ~ ...... _ ..... House Number Street'~ ' '~ Hamlet County Tax Map No. 1000 Section ..... /. ?..~· ........ Block ...... .~. .......... Lot .... h .2-. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occul~ancy ~' b.'Intended use and occupancy ppli bl ) ' Additi Alt tie 3. Nature of work (check which a ca e: New Building .......... on..~ ........ era n .......... Repair ; ............. Removal .............. Demolition ............... r Work ....... /~Z OOO · ~ . , (Descriplion) Estimated Cost ° Fee " (to be paid on filing this application) If dweiling, number of dwelling units .............. Number of dwelling units on each floor ................ If garage, number of cars If business, commercial or mixed occupancy, specify natu? and extent of each J:ype of use ........... ' .......... Dimensions of exi.,Stjng structures, if any: Front .... ~ ........ Rear ... ~.( ....... Depth . . ~./..~./.I. *.* .... Height ZT. Jl.~/Y.'' Number of Stories ....'"~.O ................ i .................. Din/ensions'of same structure with alterations or additions: Front ...... ,.; Rear .... Depth ...................... Height ...................... Number of!Stories ...................... Dimensions of entire new construction: Front................ Rear "'"' ii Depth Height .............. Number of Stories ........................ ' Size of lot: Front ..... 7.d~..*. ~. .......... Rear .... .'7..~.t. .......... i'''iiDept .... ~" ......... Date of Purchase ./~l~t~.~..../.~.7..tI .............. Name of Former Owne} ~.~.~.. 11. Zone or use district in which premises are situated ...... ~. ................ i .............. 12. Does proposed construction violate.%ny zoning law, ordinance or regulation: .... i.,~. ~. ...... 13. Will lot be regraded ...... ~,~ .,: ~.~,._O..... ...........Will ex~ce.ssfill be removed from premises: ~ No 14. Name ~f ~wner ~f premises ~.`.H. ~ (.~.`~.g. ~.~A~. .`th`~. . . Address ~.~..'~.~. ~.~.E.~.~. l,¥.. PhoneNo ~.~'.~'.~..~t~.~d~ Nmne of Architect ........................... Address ............... ~. Phone No Name of Contractor .......................... Address .... ; .......... .... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit may_ be required. 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. ~£~ t~rr~led/~b ~£o~ 9. 10. APPR/O rD AS NOTED FEE: / NOTIFY BUt' "lng ~, e~nm~ENr AT 765-~2 9 AM ~ 4 ~ FOR THE FOL~WING INGPE~ONS: ~* FOUNDA~ON ' ~ REOUIRED FOR POURED CONCR~E 2, ROUGH. ~MING ~ PLUMBING 3. INSU~ON 4. FINAL CONSTRU~IO~ UUST BE COUPLER FOR C.O. ALL CONSTRUCTIO~ SHAL~ UE~ THE REQUIREMENTS OF THE N.E STATE CONSTRUCTION & ENERGY CODEs. NOT; RESPONSIBLE FOR OFSIGN OR cONSTRUCTION ERRORS STATE OF NEWYOE.K~ . l COUNTY OF · j~.O!b.O,r ~...~.. j(~S....~..O¥.12. ~ .~.~ .[!.O:./7 ........... being duiy sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................................. i ........................... (Contractor, agent, corporate officer, etc.)i ,,~ 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 o[his knowledge and belief; and that the work will be performed in the manner se't forth in the application filed therewith. Sworn to before me this ....... . .~..~.. · .~. · .......day of..]~)..~'. Nota. Public, ,.~.~/~.~.Q.//~ .... ~... County~ N~A~ PUBUC, ~ ~ N~ : No. 62~ 2688- ~mml~n ~ (Signature of applicant)