The URL can be used to link to this page

Home My WebLink About19839-Z IPORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERA~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_e lC)8~9 Z Date. Permission is hereby granted to: ~ _ -- ,/~,,~...~~~.~. )...~.~.../~~ . ......~~~..,..~...,....~~ ,~ .~~.~,~,,...~~..~..~u~~, .:.~. ~...~....~..~,~_~,.~ ~.~...~......~ .- ...... ~ ~ ~ .............. pursuant to application dated ...... ..,~.../ _~.~. ...................................... , 19...?./., and approved by the Building Inspector. B~dlng Irupector Rev. 6/30/80 FOUNDATION Ilst} FOUNDATION ( 2nd } ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: III Ir d ~ TEL.: 765-18013 Examine 19 Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 BOARD OF HEALTII ..~.~ ...... 3 SETS OF' PLA~IS .......... SURVEY .................. c,l c cn .4J.-,'a ..... SEPTIC FOR:I .............. CALL r-~dO-". /, d.t~ ~/ ...... NAIL T 0: (~dd~ ~/ (Bm'ldinypector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Ttfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .'ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl/- atio. n. c. The work covered by tkis application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~al~,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 Jail have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depv~ment for the issuance of a Building Peri, lit puisuant uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. tie applicant agrees to comply with all applicable laws, ordinances, buildine code,/~using e, and regulations, and to /mit authorized inspectors on premises and in building for necessary insgec~l/~// { /\ -- (Si=nature of appliqddt, o nan]e, if a corporation) (Mailing address of applicant) fate whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ' o01tc h[ ts leSSt ................................ ame of owner ofpremises ..... '~£.l.all,.~.g.~.,~..~.QO ........ ..... , , . ' (as on the tat roll or latest deed) applicant is a corporation, signature of duly, authorized officer. " ....... '(I~/;Me' ~/)titie' ~ ~c~)'l;~r~i~ ~?~ri ......... Builder's License No.. -~.l~ .................... Humber's License No...~/.~ .................... Electrician's License No..b'//t ................... Other Trade's License No..~./j ................. Location of land on which proposed work will be done .................... L ................ }louse Number Street Hamlet County Va× Map No. 1000 Sec,on ..... /.5(( ......... n~ock ..... 5(. .......... Lot ..... ~q ........... Subdivision ..................................... Filed Map No. (Name) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing useand occupancy ,l)atc,0~f,s~ [ / .6fO c .............. ' ' o ................ b. Intended use and occupancy ...~..~.,..(-?.~!3.5.{./1 ........ lh~" ~" '"" .-" ':'q '~ ~,.~ .. ~.~,;., ti, i ......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . Repair .............. Removal Demolition ........ .............. ' ............. O li?rk 4. Estimated Cost. · t ............................ Fee ...................................... j~ (to be paid on filing thisra]~,plication) 5. If dwelling, number of dwelline units ............. Number of dwelling units on each floor. If garage, number of cars j~ .... ,,W.. ..... 6. If business, commercial or mixed occupancy, specify.nature and extent of each type of use 7. Dimensionsof. existing structures if an,,' Fron' ~-~-~ ,. ^,' '-' a' ':,, ........... H-;-~-* ~ U' ., -' ' ·; ............. ~ear ...l-I- ......... Denth ~,6 ...... ,., .......... rqumber of Stories .. l ................................... '. .............. ~'' Dimensions of same structure with a.! [ Depth ...~ta~.... te ations or additions: Front . .~.t~ .......... Rear . Iii..t~. ......... · · . height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear Depth Height ............... Number of Stories .............................. 9. Size of lot: Front ...~ . ~.$.L,...5. ........... Rear ....................... I0. Date of Purchase ................. Depth 11. . . ': ........................... Name of Former Owner Zone or use dmtnct ~n xvhich premises are situated t~or~,m~t~ [ ~,m~ ............................. 12. Does · · · '. ......... ~ .................................. proposed construct~o~jvmlate any zoning law, ordinance or re lat on' ~. 0 13. Will lot be regraded 0 ............................... · ' '. ........................ Will excess fill be r moved fro~ 12. emises: Yes No 14. Name oO[ AOr~7/e~ premises .~rl(ttx.Pt~.L.~'O ..... Address ~.q~.q. t~ .c0.~.~.t.u.~..~..,F.~hr~No .......... Name ........................... Address ................... Phone No .............. j. Name of Contractor .......................... Address ........ Phon~No ................ L5. Is this property within 300 feet of a tidal wetland? *Yes'...' .... '.' No..~ ..... · 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 frorfi ~roperty lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether :nterior or coruer lot. A'r~ OF NEW~XZORK_~x& 1// S S )UNTy · , ..... ~J' '/7; ~' ~. ~':~/~./t.e~.~ .... being duly sworu, &poses and says that hc is ,Ac applicant (Name of individual signing ~tract) [ eve named. is the ~ ~ ~( r (Contractor, agent, corporate officer, etc.) ............ ' ...... said owner or owners, and is duly anthorized to perform or have performed the said xvork m~d to m~e and file this dication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be perfomed in the manner set forth ia the application filed therewith. ~m to before me this ........... ...... ...... ' ....... [ I I UNDEIh~,~TERS CERTIFICATE R£QUIRED