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Home My WebLink About23275-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 23275 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN'f IL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby grant _ ~ ~ . ~.~ .......... ~~.~. ........... ./..~.~.....~..yr..,, .................. ,o .......~..~...~~.~...~......~....¢~.~, :~.../,.~ ............. CounlyTaxMaP No. 1000 Section ........... ~..... ..... Block ...... ~ ............. LotNo../,~,¢,..~ .... pursuant to dpplioatlon dated ....... ,...~. ,.~..,,..~.~., ..................... 10'"~' "~" ....... and approved by the Building Inspector. Fee~..¢.~.~ Rev. 6/30/80 j E×fllllJlled Approved BUILDING DEPARTMENT FEB I 3 1996 . TOWN HALL $OUTHOLD, N.Y. 11971 BLDG,,, OEP:A ,.:/2~ TEL.: 765-180~ 3 SETS OF PLANS .......... SURVEY * .................. CIIECK .................... SEPTIC FOItH .............. Disapproved a/c ..................................... · // (B.,uildin~ luspector~ ...... ~E~"~l~-f;:r~'~-~ //- · " _ F - - . TOWNOF~O~? ¢~O r~ P~N FOR BUILDING PERMIT .................... ::'"':~ DMe ................... 19... tlo? I FY ~ GALl, ................... HAIL TO: INSTRUCTIONS a. Tiffs apphcatlon nust be complete y filled ill by typewriter or ill ink and submitted to tire Budchng I lspector, wdh 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sbowhlg location of lot and of buildh~gs oo premises, relationship to adjoining premises or public streets or areas, aud giving a detailed description of layout 9f ptopeyty must be..drawn on the diagram which is part of this appli- catiou. c. The work covered by thi~ application may not be commenced before issuance of ~uflding Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the appliCant. Such pmmit sltall be kept on tbe~.:or~mises available for inspectiou throughout the work. e. No buildiug ~hall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupmmy shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE 1o the Buildh~g Department for the issuance of a Budding Pernut pt rs~ a d to the Building Zone Ordinance of the Town of Southold, Suffolk County, NeW York, m~d other applicable Laws, Ordinances or Regulations, for the construction of buildings, addit'o~s or alteratious, or for removal or demolitiou, as hereiu described. The applicant agrees to comply with all applicable laws, ordinances, building code, bousiog code, and regulations, and to admit authorized inspectors on premises aud iu buildiog for necessary~spectious. (Siguature (Mailiug address of applicant) State whether app)j.~aut is owner, lessee, ageut, .architect, e lg lee', general ..~ontra~tor, electrician, plumber or builder. 0 ~o~d~ ..... ~ ................................ or ow,er or pre,uises °. . .................................. (as oil tim tax roll o ~ ~test de,ed) If applicant is a corporatiou, signature of duly authorized off'cer. (Name and title of corporate officer) Builder's License No .......................... lqumber's License No ......................... Elect c a 1 s License No ....................... Other Trade's License No ......... .............. Location of land Oll which proposed work will be done ............................... ~ ;~; ................ . r- r) ........ ........ llouse Number Street Hamlet ..... County Tax Map No. 1000 Section .' ................ Block ................ Lot..(~t .............. Subdivision. .................................... Filed Map No ............... Lot ............... (Name) , State existing use aud occupancy of premises and intended use aud occupancy of proposed consttuctiou: a. Existing use and occupancy . .~flgld~ f .iA~ ...................................................... b. lnteuded use mid occupancy . .l¢¢$Jd~O~/~L... '. · . .' ............ 2 · J.'. .............................. 3. Nature of work (cheek which appli~ab e): New Building ......... , Addition .......... Alteration .......... Repair .............. Remorai .............. Demolition .............. Other Work ............... (to be paid on filing this application) 5. f dwelhng, nnmbor of dwelling nn s ............. Nmnber of dwelling units on each floor ................ . If garage number of cars ~ .... Il bnsmess, commorcml or nnxed obcupancy specify natnre a ~( extent of each type of uso 7. Dimensions o~ existing atmctnres, Lf any Front. ~ ~.~b.~ ..... Rear .............. Depth ............... lleight ............... Nnmbek of Stories ........................................................ Dimensions of same structure with ]alterations or additions: Front ................. Rear .................. Depth ...................... ltteight ...................... Number of Stories ...................... 8. Dimensions of entire new construe(ion: Front .D.~ .......... Rear ............... Depth ............... lleight ............... Ntnnbe~ of Stories ........................................................ 9. Sveoflot: Front 5.~.~..; ......... Rear ..... Depth 10. ~ate of lmchaso ..... t.]..g~..; ....... · ......... Name of Former Owner .~gO..~A~gg~ .............. I 1. Zone or use district in whlclt premi~os are sitnated ..................................................... 12. Does proposed construction violate] any zoning law, ordinance or regulation: ' . ................ 13. Will lot be regradod ... ~ 9: .... ; ................. Will excess fill bo removed from premises: Yes No 14. Name of Owner of premises .$ ~. ~.& .~p~... Aa&ess .a~ .............. Phone ~o. Name of Architect ~ Addr Phone No ' · , ......... ) .............. eSS ................................... Name of Contractor .... ~ ...... :. · Address Phone No 15. la chfs property wf~h~n 300' feac of a ti. del we~land? *Yea ........ a~f yea, Souchold To~n Trustees Perm~C may be requ'tr&d. ' .... PLOT DIAG RAM Locate clearly aod distinctly all bffildings, whether existing or proposed, and indicate all sot-back dimonsmns kom property lines. Give street and block nnfi~ber or description according to deed, and s ~ow street names and indicate w tether interior or corner lot. NOTIFY BLllLO,I~G DE--AT FOLLOWING iNSPE,~IONS: 'L FOUNDATION -~ '~OREQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. JNSU~T~ON 4, FINAL CONSTRUCTION MUST B~ COMPLET~ FOR ALL CONSTRUCTIQN 8HALL ~EET TNE REQUIREMENTS OF ~E STATE CONST~U~ION gODE8, N~ RE~PON~B~ gq'ATE OF NEW YORK, 20UNT¥ OF., jM.~.q, y~q .~..,... (Name of indivkhnd signing ~.~: .~..fl'~. .......... being drily sworn, deposes and says that lie is the applicant :ontract) le is the (Contractor, agent, corporate officer, etc.) i . Il' said owner or owne,'s, and is duly at,~tbonzed to perform o,' have performed the said work and to make and file this q)plication; that all statements containe~l in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the mannor aet~forth in the application filed therewith. ~wom to before lne this qotary Public,~7~"~ ~h~L~o~ ~e~tY~ /