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Home My WebLink About19011-Z IPOBM ~0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- I c)011 Z Permission is hereby granted to: ...... ~ .................................... : ...................... ..~~~...~.:.."J.:....)..!.~.~.! .............. County Tax Map No. 1000 Section ..... ..(~...~...L? ........ 8lock ......1~....~. .......... Lot No.....(~...~....~ ........... pursuant to application dated ......... ~.......~....~.. ..................... , 19...~...~.., and approved by the Building Inspector. Building I~tor Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FOR~ ............. : TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1BO~ CALL - MAIL TO: 19.q.o. Approved ....~..&%~! .~ .... 19~.0. 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 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 which is part of this appli- cation. c. The work covered by this application may not be commenced before ise-apce cf Build~g Pemfit. .. avv ...... .o.~, me ~uumng inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throu~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc3 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 o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, es herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on.l~r~ll~ses and in building for necessary inspections. ff/(Signature of applicant, or r~me, !f a corp.ora, tio, n): (Mailing address of applicant) . state whether applic ' is owner, lessee, agent, -chitect, en neer, general contractor, electrician, plumber or build:r. ]fappEcant is a corporation, signature of duly authorized officer. FEE: J-~", ""-' BY: ~/, ('~'~ '/-"' NOTIFY SUIM)ING DEPARTMENT AT 7654802 9 AM TO 4 PM FOB THE (Name aha title or ....... . OU.OV .G'"SPECT'O"S 1. FOU.D^T,O. TWO · 2. ROUGH - FRAMI~ & PLUM_~ING Plumber's License No. 3. INSULATION ........................ 4. FINAL CONSTRUCTION MUST Electrician's License No ....................... 8E COMPLETE FOR C.O. ALI. CONSTRUCTION SHAM. MEET THE REQUIREMENTS OF T~E NY. Other Trade's License No ...................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR I. Location of land on which proposed work will be done ............. ~ ·. DESIGN.QB CONSTRUCTION ~:R.R.ORS ..... House Number Street Hamlet County Tax Map No. I000 Section ....~. -2 ~ ........ Block ..... Q.. 2 ........ Lot Cr~ / Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ....... : ' ......... ~' ............... ~- .~:: :,: v* ........ . .... : ............ b. In!ended us.e and occupancy ~.0...~ .O'f.. · -'~. - · · -~. ~.. ~...'~.,~ f~ ..... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alterati_oq~ ........ ·. Repair .............. Removal .............. Demolition .............. Other Work (D e s~:'rip.tion ) 4. Estimated Cost .~.. ~..~..~ ........................... 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 ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .......... · ..... Rear ............... Depth ............... Height ............... Number of Stories ............. . ...... 9. Size of lot: Front ...[ ~. 0 ............... Rear ........ /.,~.v. ......... Depth .. ~ .~.~'. ............ 10. DateofPurchase ............................. Name Qf Former Owner .k.c/.~',4~..~ ....... 11. Zone or use district in which premises are situated .... .ft4~~-r .~. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .'~..x'X~.... ;'~ ........................ 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 of Contractor .......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... ~If yes, Southold Town Trustees Permit maybe 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. ' STATE OF NEW YORK, S.S COUNTY OF ................. ...... ~ .~. · .~.~~ ....... being duly sworn, deposes and says that he is the applicant u (Name of individual signing/contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 t~is ............... ;...: ..... day .......... Notary Public, . uniy No. 4981364 ' .' (Signature of applicant) Qualified in Suff~c County O, ' -