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Home My WebLink About17566-Z · 0uM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL 'lot COMPLETION OF THE WORK AUTHORIZED) 017566 Z Dote ...... ./..~/..:?...~ ................................ , / County Tox Map No. 1000 Section ...... .~..~...~.... ..... Block ............ ..~..~.... Lot No ........ ..~/~.~..~. pursuant to application doted .... ./.~..././..~.. .................................. , 19x~., and approved by the Building Inspector. Rev. 6/30/80 BLDG. OEPT, TOWN OF SOLITHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH 3 SETS OF PLANS ~141~iii .... SURVEY ........ Q-.~ .... CHECK '7'/= /~°~ ''. '' SEPTIC FORM ~ Approved ./.~/. ,~ .?, .... 197~Pe rmit No../..~ ,~.~, .~, ,~ Disapproved a/c ..................................... .............................. APPLICATION FOR BUILDING PERMIT NOTIFY CALL INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of th.is appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for/-emoval or demolition, as herein described. The applicant agrees to C$.~RIy 5vj.t.~.~,applicable laws ordinances, building code housing code, and regulations, and to admit authorized mspeetofs~napr~m~'s~ and m buildmg for necessary inspections. .... ' ' ...'.xmz,~.c~,.I.~..'-~..e:'~...~...d .......... .......... .,~v, ......... '. (Signature ot applicant or name if j/corporanon) ': ~,-,.~ :,,' ' '," ':'. ~ ' ~.~.9~./,4;~.,,v.$..&..t.. 5%.~.,..~.o. ....t'"; ,'. ';' (Mailing address of applicant) State whether app lcant .~s:~wner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ~-,- ~ · · 7 !:.;: ........................................................................... Nam e o f owner o f premis?s . / J'P0~/].S.. ~..~. ~./?./5..77t .,~. ~... 0..~.c.~: ................................. (as on the tax roll gr latest deed) If applicant is a co. rporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~ .......... PI tuber s License No ......................... E cctnclan s License No ....................... Other Trade's License No ...................... Location of land on which proposed work ,,vill be done..~.~.' ?.~.-7... ~40.t~.'~O~O .~....~...~cO .d. ~.-7! .l-.O..~) ........ I ·..-5-~ ~ ...~. ........... ~ ~v.o. ~. 5...'.~-.. ,v .~-.'-... ~i, ~:- ~o~-O .... House Number Street Hamlet Map No. 1000 Section .... 0.'~.~.~/. ....... Block .... O-"'~ .......... Lot O .~.'...~./' County Tax Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~tate existing use and occupancy of premises and intended use and occupancy of proposed construction: - Existing use and occupancy . .C~ .~.~.--'~..~..~..~O,.I. .~.y..~).'qJ./'~.=..L~..~.~a, ..... . ......... b. mtended use and occupancy .... ~ ~ .O. 3. Nature of work (check which applicable): New Building '. .... Addition .......... Alteration psi Re r ......... ....... Removal ..... . ...... Demolition ........... ... Other. Work .... (Description) 4. Estimate'd Cost . . . ./(..O~.,.t.?~ .......... ' ........... Fee ............. ' ' · . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ..... ' If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type 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 Depth ...................... Height ................. Rear .................. ...................... Number of ~tories ............ ~ ........ 8. Dimensions 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 in which premises are situated ......................... /e~ .......................... 12. Does proposed construction vi,olate any zoning law, ordinance or regulation- fl~ ,~ ........... 13. NWfla~l leot be regraded .....~.~ .................... Will excess fill be r;n~;v;~ flo'n~ 'p'r;~ni;e's; ....Yes No 14. of Owner of premises .................... Address ................... Phone No ................ Name of Architect ..................... ; ..... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ........ ]5.Is this property located within 300' feet of a tidal wetland? *YES...~I~)'.~-: *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleaxly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frem property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED DATE: /~ /'~7/.~".~'B.p.I / ?,,~'"~ FEE ? ~ ?'~"~'~ '- ~/~O ~ NOnFY BULLDOG DEPARTMENT AT 765-1802 9 AM TO 4 PMFOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION . TWO RE(~I~RED FOR POURED CONCRETE 2. ROUGH - FRAMING & PUJMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF ................. S.S ............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) .... lbove named. {e is the (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this :pptication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this .......... ; 7 dayof ............. 19 .~.J:- ;otary Public ...... ?'~''-~'~';' '/J'e../~L~, .... County _.~.~.~,~:5~<//~ t::ff_.~ (Si~e of applicant) 1 OCCUPANCY OR USE IS iUNLAWFUL' WiTHOUT~ OERTIFI,CAT£ ~07 OCCUPANCY