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Home My WebLink About24202-z lvO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~AIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 24~o2 z Do,,..,~......~ .................... , ,,...?~ Co,,n~ To~ Mop No. ~o0o Sec,o, ..... ./..~,~. ~,~-"~.. Lo, ~o ~ -./. Building Inspector. Rev. 6/30/80 For{M NO. 1 TOWN OF SOUTtlOLD BUILDING DEPAfVfMENT TOWN IIALL SOUTIIOLD, N.Y. 11971 Disapproved a/c APPLICATION FOIl BUILDING PEI1MIT B~)ARD OF IIEALTII SURVEY ClIEEK ...... CALL .... , .... HAIL TO: 1, FOUNDATION - TWO REQUIRED FOR POURED CO~CRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION 'MU~T RE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE 'REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR Location o£ land on which proposed work will be roue. -,- .............. ~, DESIGN .OFt CONS'i:P, UCTION .ERRQCJ~I... Ilouse Nunlber Street Ilamlct Co ~ty Tax N~ ' · u , o. cc on ..; ......... oc .............. Lot .... ' ............. State exiHJug u=c and occupancy or premises and iuleudcd usc ami occupancy, of proposed conslruclion: Builder's License No .... , ............ '.. ........ Plumber's License No .... ........... . .......... Electrician's License No ....................... INsTRUETIONS a. Tiffs application must be completely filled itt by typewriter or iu ink and submitted id the Building Inspector, with \sets of plans, accurate plot plan to ~cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises 0r public street' or areas, and gN~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this appli cation. c. ' The work covered by tiffs application may not be commenced before issuance of Building Pemit. d. Upon ~pproval of this application, the Building Inspector will issued a Building Pe~it to the appllcant. Such pemit sh~l be kept on the premises avagable for inspection throughout the ~work. '. ~. e. No building shall be occupied or used in whole or in prat for any Imrpose whatever fintlI 8.~rtificat'e oF Occup~cy shall have been~ranted, by tfi~ Building Inspector.. . . ~ ~., -' ~. ~ ...... ' APPLICATION IS IIEREB~ MADE to the Building Dep~men't for' the issuance of a Bffilding Pemit punuant to he Building Zone Oqlinance of (he Town of Southold, Suffolk County, New York, ~d other appHcabie Regulations, for ~)? construction o~ditions or alter~tions, or for rem~l ~r demolition, as here~ described· The.applicant age.es to co~ply wi~~e taws, ordinances, building co~, ~ousing~de,.and regulations, and to admit authorized insp~ctom on pre.es and ~ I;ffild~g for necessa~ iuspec~~~ff State whe~ applican(i~ o~ner, lessee, agent, architect, r~ngineer, gene~aJ?c0ntractor, electriciah, ~lumber or builder, '~ .... ~ . .~. ........ ~-~ 7654802 9 AM TO 4 PMFOR . ~ (~e and title of coUmr~te o~ficer) FOLLOWING ,3. Nature ofwork (check which applicable):, New Building .......... A~Idition ..,~,,..,. AltdDtion : ....... Repair ....... ; ...... Removal ......... ..., .... DemoJiti6n .. ' "'' ~' ~ ~6 ~ ~ (Description) 4. Estimated Cost ... ~ ........... ~ .......... I:~e ................... ~?; .............. ~ i ((o be paid on hhng~bjs application) 5. Ir dwelling, nnmber oCdwelling uhits ..... Nmnber oFdwelling units on e~lch Iloo~ .............. If garage numberofcars 6. fbusmess, commercml or mixed bccup mcg, specify n:itm'e ami extent of each type of use ... ! ............... 7.D'llllellslo~lsot .... ex~stlngstmctures,'~ifany: Front ............... Rear .............. DelCd~ .. Height NumbOr or Slodes . Dimensions'of shine shucm~e witl~ alterations or additions: Front ................. Rear . ............... Depth ' I llei~d~t ' Number of Stories . 8 D' or .i ~ . I}lellSlOllS ~1 ro llew co lstrtlcllon: :rollt ............... Rear ............... De lleight ............... ~mt r o[St(~ies ................ t ...................................... ~. si~ or ~ot: ~,~o,,t ......I.~,. ........'3 . ~.~. ..~..,O~ . ,~pth ~.O ~ ~ ' IO. Date of Pt rc ase ............. ...... · ..j .~N:uneorFo,nerOwner .{ ................ I 1. Zone or use district in which premigesare situatt.d J.~l~.. 2; .......................... ' 12. D~es proposed constn,ct~ont%iolatei, any zoning law, ordim,,,ce or ,egt, latio : 14. t~a,ne or Owner of premises ~.~1~.~. ~ddressP~5 ~0 .~~rf~ne Name of Architect ............. 1 '~ ............ Address ................. Phone No ..... . 2.. [5.' I~. this prOperrty wltbln. 300~feet of a tidal wetlm~d'? *Yes., ...... ~If yes~ Southoid Town Trustees Permit may be requi'red. PLOT DIAGRAM . ~" .,~ ',' Locate dearly and dis'tinclly all buildings,'x¢heth~r existing or,~,roposed., afld.'indicate all set-back dbn ensiohg ., .merty lines.x Give,,,,street, mid,biock, num~er'or, desc~ priori according to deed, afl'al'show street names and indicate wtmthe or or come, lot. ; ... , ~ ~Zz , , ,..... ...... ',~./.~:a~:~ I bein!t duly swol n, dqmses and says that he is the app ~cant (Name,t~f mthv]dtml signing cont~c ) )venanicd. "'~ ' , .:~1,,, is lhe . .',... . .................... (~onlraclor, a/:e,]t, eo,po,'a,: officer, etc.) said owner or ownerg, and is duly authorized 1o pcrform or have pesftumed the said wolk d/cation: ' Ihnt all statements ?nJamcd m il ts application are, tsue ~o l{~c best uI' bis knowledge and belief; and that the :k will be performed in ibc ma'n~i'cr set 'fo/ih [in thc apldicalion filed flie~ewilh. ' ~ 1o before me this i