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Home My WebLink About16988-z ~Olt~ NO. ~ TO~H OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 16988 z Permission is hereby granted to: ,, . ..~.~..~.....~_~ ......................... , ,o ...'~.,.~...~..~......&~,.....~.~....~..~.~....C.~.'.-...O... ~"'"~ "' "~'"'¥w~'~'"~ "~;~'"'~'"'¥":","'"~ ........ i'"' .... ~ ......... !'";: ............. at premises located at ....~..~.......~...~~..~ ......... -~.~ .............. County Tax Map No. 1000 Section ...... .~...~...~ ........ Block ........ .~:~.J ....... Lot No.....~."], .............. pursuant to application dated ..... .~......~.~ ................... , 19.~...~..., and approved by the Building Inspector. Rev. 6/30/80 BLDG, TOW'~J OF $OUTHOLD (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF H~ALTH ...... B SETS OF PLANS ....... FORM NO. 1 SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEETIC FOKM ............. : TOWN HALL NOTIP¥ 8OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL .... MAIL ;0': Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in b.y,'gtp~WrRe~-~r tn_i~kC~t~l ~i~m~d to the Building Inspector, with 3 · sets of plans, accurate plot plan to scale. Fee according~lsch~drl.l~:9:DJ&lOt~ ' b. Plot plan showing location of lot and of builder,s ~ht~'nt'i~4~/Bfe/fatfb*hslt.~[t._~,~fljoining premises or public streets or areas, and giving a detailed description of layout Of~lSro~¥t~.~t~tt~rdr~xChtqJn ~cd'iagram which is part of this appli- cation. c. The work covered by this application may notl~eic~mfnenced,~¢~'oreus~u35fc~ di~ B~ildmg Permtt. d. Upon approval of this application the Building~Irt~dFo~lii,~l~iss~e? a Build~ ~e.~r~, it to the applicant. Such permit shall be kept on the premises available for inspection e. No building shall be occupied or used in whole ot;~ilttl~t~i~lh~1~'O~ v(,h.a,,teve,r until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuadd~ 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 o~ Mteiafions, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lac'~aprdinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildin~ ~ necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ................................................................................ Name of owner of premises . .~../../~....~. ~....~.~.[~. ~..~...~.~.c...~....~....~...~..~ ........................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duty 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../'~.. ~'¢~ .~.-. c~..,~. 1. ..... . . ...... . . . . . ........ House Number Street ~ '~ Hamlet 'County Tax Map No. 1000 Section¢.. ~ ....... Block ...4 .............. Lot....~./. ........... Subdivision ..................................... Flied Map No ............... Lot ............... (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 ~-~..~-a~-~ ....... ~ .... /-~...~..~ .................. 3. Nature of work (check which aPplicable): New Building ..... ' ..... Addition .......... Alteratio~ . i '_' :' .... Repair .............. Rem?al ...' ........... Demolition .............. Other Work..~.., i (Descfiplion) 4. Estimated Cost ................................ Fee ......... ~' (to be paid on filing this application) 5. If dwelling, number of dwelling Shits / 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. Dimensions of existing structurels, if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimansions'of same structure with alterations or additions: Front ........... Rear Depth .................... i' ' Height ...................... Number of Stories ...................... -~8.. Dimensions of entire new constrUction: Front · ............. . Rear ·. ............. Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front .... ~.5~....i ........... Rear. ~..~g~ ........... Depth 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which prelm]ses are situated ..................................................... D ' 12. ocs proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... : ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. , ................. Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name 0f Contractor ......................... Address .... ; .............. Phone No ................ 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No .~f.'. · If yes, Southold Town Tru ~tees Permit maybe required. PLOT DIAGRAM Locate cleariy and distinctly all ibuildings, 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. APPROVED AS NOTED FEE: 785,1802 9 AM TO 4 PM FOR THE SO.OWING INSPECTIONS; I, ~OUNOAT~N · ~O REQUIRED ~ ~URED ~NCR~ 2. ROUGH - ~MING & PLUMBING 4. FINAL CON~RUCT~N MUST BE COMPLETE FOR C.O. A~ CONS~UCTION SHA~ MEET ~E flEQUIREMENT8 OF THE N.Y, STATE ~N~U~ION & ENERGY ~DE8. N~ ~8~SIBLG FOR , DESIGN OR C~TRU~ION ERRORS STATE OF NEW YORK, ~.S COUNTY OF .................. .............................. : ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. , He is the ....................... i .................................................................. I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this application; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this .............. Or. ........ day of...~ .......... , 19~.~. .~/ ,,,-., ,/I ,it., Notary Public .... .~..~.,, .i~..~r'. ~'f.~f~. ..... County ~-g ~