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Home My WebLink About16002-zTOW~ OF $oulr3..IOLD BUILDING DEPARTMENT TOWN. HALL / / (I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PIdLL COMPLETION OF THE WORK AUTHORIZED) '~L,° 00~ z ~o,, .......... '.~.%..~-~ ......... ~,~.~.. Perm~ss{on is hereby granted t~.: . ~ .._.~.~~.....~.....%.......!.~..~.~ ro ..... ~ .......... ~.~ .... ~n.~.. ........................ , ............................... at premise located at .,,~,~,__~.~.~,.~...~ ...... ~~ ................. co..~, ra× ~ap No. ,000 S..t~o,, ..... l.~.l ..... ~,ock ....... .~.~ ....... ~ ~o ..... pu.uont to application dat~ .... ~.~.~ ............... ' 19'~'1'" and approv~ by the Building Insp~tor. Fee $. ~...%..~... Building Inspector Rev 6/30/80 OUNDATIO:; { 1st) OU~DATIO:; (2nd) OUGH FRAME & ?LUMBING NSULATION PER N. Y. STATE ENERGY CODE FILIAL ADDITIOn;AL CO~.MENTS: Examined Approved . Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N Y 11971 TEL.: 765-1802: ~Oqea4.~ ~.a~, 19 ~'.7 (Bmld~ng Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: Date APPL!CATION FOR BUILDING PERMIT INSTRUCTIONS a. Ttus apphcation must be completely filled m by typewnter or m ,nk and submitted to the Bufldmg Inspector, wit , sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showmg location of lot and of buddings on premises, relatmnship to adjoining premises or pubhc stre or areas, and glvmg a detailed description of layout of property must be drawn on the diagram which is part of thru ap cat, on. c The work covered by thts apphcatmn may not be commenced before issuance of Bufldmg Permit d. Upon approval of this apphcatmn, the Building Inspector will issued a Budding Permit to the applicant Such pe~ shall be kept on the premises avadable for mspectmn throughout the work, e. No bmldmg shall be occupied or used m whole or m part for any purpose whatever until a Certfficate of Occupm shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance- Regulations, for the constructxon of bmldmgs, additions or alterahons, or for removal or demolmon, as herein descnb The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises and m bmldmg for necessary inspections .. (Signature of applicant, or name, lffa corporation) (Mailing address of applicant) ! / ~,.5' ~ State whether applicant m owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises .. . (as on the tax roll or latest deed) If apphcant ~s a corporation, signature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S HUST 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 w~ll be done Itouse Number Street County Tax Map No i000 Sechon I ~ j Block I4 . Lot Subd~lston Fried Map No .. Lot (Name) State extstmg use and occupancy of premises and intended use and occupancy of proposed construction ' a Existing use and occupancy ~ {.v~ ~.¢ .... ~'m I ..... b Intended use and occupancy ~ ~ C~. {1 / 3. Nature of work (check which apphcable) New Budding .. . Addmon .... Alteration Repmr ..... Removal ...... Demolition ....... Other Work .... -4~ (Descnp.tion) 4 EstlmatedCost ~ ................. Fee ,,~...'...'~. ....... (to be paid on filing this apphcatlon) 5. If dwelhng, number of dwelhng units .......... Number of dwelling umts on each floor .... If garage, number of cars ......................... 6 If business, commercml or mixed occupancy, spemfy nature and extent of each type of use .. 7. Dimensions of exmtmg structures, tf any. Front ...... , ...... Rear ............ Depth ............. Height ........ ,}Number of Stones ........................ Dtmenmons of same structhre with alterations or additions' Front ......... Rear ...... Depth ....... Height ............ Number of Stones ................. Dimensions of entJre new constructmn Front ........ Rear ............. Depth Height ........ Number of Stones .................................... 9 Size of lot. Front ............ Rear .................. Depth ............. 10 Date of Purchase ................ Name of Former Owner ................... 11 Zone or use dmtnct in which premises are situated .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation ....................... ~.... 13. Will lot be regraded ............. WdI excess f'dl be removed from premises Yes ¢¢w N, 14 Name of Owner of premises .......... Address ............. Phone No .... Name of Archlteet ................. Address ........... Phone No .......... Name of Contractor ............... Address ........... Phone No .......... ?.. 15. Is thio property located within 300 feet of a t~dal weCland? ~Yes ..... No ..... *If yeo, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and lndmate all set-back d~menslons frou property hnes Give street and block number or descmptJon according to deed, and show street nantes and indicate whethe interior or comer lot. '8. OF OCCUPANCY USL WITI-,- OF OC(, 'CATE STATE OF NEW YORK, S S COUNTY OF ..... (Name of ~n&v~duaI mgnmg contract) above named APPRO D A8 NOTED NOTIFY ~IL[?NG DEPARTMENT AT 7~ 1P02 q I~,~, TO ~ ~ FOR I~E FO~, OW4','c-, r~O C}eQU1RED ~O,,t'~ ..... *~,mNL ~ ~LUMBING A, '~q~ , ~,,*cc MEET · being duly sworn, deposes and says that he ~s the apphcan He is the ............... (Contractor, agent, corporate officer, etc.) of sam owner or owners, and is duly authorized to perform or have performed the smd work and to make and file thl apphcatlon, that all statements contained m this apphcatmn are true to the best of his knowledge and belief, and that th~ work wdl be performed in the manner set forth ~n the apphcation filed therewith Sworn to before me this ....... /~ ... dayof. Notary Pubhc, ~../g~'~. ...... ': Count~-~ ~ ~.~ ";~qY 1~8U~, ~al'~, ~ Y~ HEI.~ & DE V OE ~' ~SJ~nat~f a;ph~n~