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Home My WebLink About22678-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. N~ 226?8 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: '...T.o..~. ~~... ~~ ........................... ,~,,/....~.~ ~ ............................... . i. . ./. .~ . . . . . ~ ........ ~ ....... ~ ....... ~. . ..~ ........... ~, , .~. . . . . ~~) ~= ........... ~ .............. ~ ........... ~.~ .................................................................. CountyTaxMap No. 1000 Section.,,..~.~.. ............ Block ........... i~.../..../.... Lot No ........ ../..~ ......... pursuant to application dated .......~.../.~,..~. ............................... 19.......~...~ and app,oved bythe Building Inspector. Fee $......~..~...~.-. ..... Rev. 6/30/80 't Examined ...... .~//~..~... Approved ....... FORM NO, 1 TOWN OF SOUTHOLD " BUILDING DEPARTMENT SOUTN,~ ~), N.¥. 1197i' TEL: 765.1802 ., 197.~. · , 19?CPermit No .... Disapproved a/c ....................... noa~o or ~IE^LYtF": ....... SURf/kY ................. CI/CCK SEPTIC .............. ''' ;ORH CALL .......... HAIL TO: ; ~, / ) / APPLICATION FOR BUILDING'PERMIT ) .. ~ -,7:-:-7,..~' ~ ~ ' ., a. TMs application must be completely filled in by ~pewfiter or in ink and submitted to the BuildMg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pl~ show~g location of lot and of buildMgs on premises, relationship to adjoining premises or pubUc st?eets or areas, and givMg a detMled description of layout of property mu~t be drawn on the diagram which Js pa~ of this appU- cation. ' , c., ~e work covered b~ tMs application may not be commenced before issuance of Budding Pe~it. ' . d. upon approval of th:s application, the Building Inspector will issued a BufldMg Pe~it to the appficant. Such pe~it sh~l be kept on the premises avaUable for ~spection throughout thc work. & No buildMg shall be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy shall have been granted bY ~e Building Inspector.. APPLICATION IS HEREBY MADE to the BuildMg Depmment for the issuance of a BMlding Pe~it pu~uant to the Building Zone Ordnance of the Town of South01d, Suffolk County, New York, ~d other appEcable ~ws, OrdLa~ces or ~egulations, for the construction of bu~dMgs, additions or alterations, or for removal or demolition, as hereM described. The appUcant agrees to comply with all appficable laws, ordinances, bufldMg code, housing code, and regulations, and to admit authorized Mspecto~ on premises and M buildMg for necessa~nspestions. _ . ............... (Signature of applicant, or name, if a corporation) 50.~'.~ ~z. .~.. ~~..~:. (Mailing address of applicant) State w~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ t% ~m~ of ow.~r of p~emise~ . ~O~.. ~t. K~T&~ ~ .Wg,.. hNP...&NN~. ~.O&~..~.~ G .... (as on the. tax roll or latest deed) ~PP~0~ED ~S ~0~ED If applicant is a corporation, signature of duly authorized officer. DAY~: ~8.P.~~ ....... : ............... a/a'. ......... . . (Name and title of co.orate officer) '" NOTIFY BOILDING DEPARTMENT AT Builder's License No ...... .K).]/~. . lumbers License No ..... .~. Electrician's License No ..... '~/j~ ............. Other Trade's License No ..... ~ ).~.'.. Location o. fland on which proposed work will be done. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION - TWO REQUIRED ·FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST SE COMPLETE FOR' C.O. .,~LL' CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ............ CODES:' -NO'I:' BESPOIgSII~LE. .... '~''~'~" ; 5E~/E~N'"~ .'~,'"~..)..~,~---/~--.:~j~..~,,~,0. ~.~,',T'. DIF. t~I~I~OR CONSTRUCTION ERRORS; ...... ~-~..% 1 .~. ....... .... .' House Nmnber Street Hamlet ..... County Tax Map No. 1000 Section ...O., .~.~). ....... Block .O. ~ ~ ~.. Subdivision. ....... · ......................... Filed Map No. (Na,ue) ........ M./A.. Lot .......... Stat~ existing use and occupancy of pre~fises and intended use and occupancy o£ proposed construction: b- Intended use and occupancy {~_,~ · .~/kl"Ak I.LW Nature ol'work (check whJch applicabl~ ,-,- ,~-- ..... . ' Repair ..... Removal ~,. ~:w m~a~mng,., .......... AddJtmn ......... Alteration ....... ' ....... · ........... ~emolition .............. Other Work... ~. ......... 4. Estimated Cost .~.tO.O. -~- .(Description) 5. If dwelling, number of dwelling units .... O.l~... (to be paid on filing this application) . If garage, number of cars . . .Q~ ........ · ·... Number cf dweliing units on each floor....~. ~ ....... 6. Ir business, commercial or mixed occupancy, peclfy ~ature and extent of each type of use j~ 7. Dimensions of existing st~ctures, if any: Front.· ........... Height ............... ~umber of Stofi .............. Rear ........ Depth .......... Dimensions of shine stmctur~ with alterations or additions: Front i~t ........... · ........ ;.. Rear ............ Depth ....................... He Number of Stories ' 8. Dimensions of entire new construction: Front .... Rear Depth .......... Height ............... N~mber of Stories ...... 9. or ......3d: .... ' 10. DateofPurchase &~l~ ~..~ ~'3 ~ ........... ....... Name of Foyer Owner WOI~X,~¢,~.~ 1 I. Zone or use district in which premises are situated ....................................... 12. D°es pr°p°sed c°nstruction violate any zoning law, ordinance or regulation .......... 13. WQI lot be re,rarer ~ k~m : ............ 14. ~Z: :[~::;:[Pr~}~{s~ ~'' .............. fll excess fill be removed from premises: Yes ..................... Address ..... ; ............. PhoneNo... iiiii .... ' Nme of Contractor ..... O~ ......... Address ~1 ~ ~:. Phone No t5.' Is th~s groperty w~th~n 300 feet of a ~dal wetlan~¢''~vo, ' ' ~ '~" ' · If yes~ Southold Town Trustees Permit may be required. .... PLOT DIAG~ Locate clearly ~d distinctly ~1 bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y Qnes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether ~tefior or comer lot. ,om to before m~: this taw Public, [,. NA~q~, TATE OF NEW YORK, OUNTY OF ......... S.S · ./klg[t . . · ' ' · ....' ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract }ore named. is the ..... .. O.~/~.~ ............. (Contractor agent ....................... ' ..... corporate officer etc ) ' ' ........ said owner or owners, and fs duly authorized to perform or have performed the said work and to make and file this plicat/on; that all statements contained in this application are true to the best of his knowledge and belief; and that the >rk v)ill be performed in the manner set forth in the application filed therewith. ' · ~ct~ote~y Pu.b. lic,~t..a~t e ?f.. Ne ~v~l~rk ............... ' ..... ,19