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Home My WebLink About22666-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ........................... ! 9 ........... 22666 Z ............................................... ~..~,..z....../...~./~ .......... ~.~...%.....,.. .............................. CountcTaxMapNo. ]000 Section ....... l/....~... B,ook ........... l ........... Lo, No...Z~,...~... pursuant to application dated ............. ~,.~., ,..~...~.2./:~ ................. 19..,~,,..-~ ...... and approved by the Building Inspector. Rev. 6/30/80 'E N BLDG. DEPT. '; TOWN OF gOUT. OLD 'FORM NO. 1 TOWN OF SOUTHOLD '3! H UDING ,DEPARTMENT; TOWN tfALL SOUTHOLD, N.Y. 1197~1 Examined~~., , 197.'(/ .TEL.: 765-1~02. Disapproved' a~c ......................... ' ....... '. .... B~ARD'OF HEA~TH ........ sETs OF PLANS ......... SUR~CY ~ ................. ClI~CK ......... CALL ~ ................. HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with .' sets 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 sti'eet or areas, and giving a detailed description of layout of property muit be drawn on the diagram which is part of this appl/ cation. c, The work covered by ttfis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such penn/ shall 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 Occupanc3 shall have been ~!.ranted bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southbld, Suffolk County, New York, and other applicable Laws, Ordinances o: Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in builfling for necessary insPegtions. ~ 'Z~--/~ .-~,.}~,,.~.' ' - ;5 - --' ]~.~..Sjgnatur~ ~f/a p151 fca n W6yC~ff're?', ~ f~-o? p b'fa tio n ) State whether applicant is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. ....O..UI.h.,~.~. .................. '.: L;. .., : 5 .............................. . ........................... Name of ownffr of premises ................. : ....................................... : :(as oh"the tax roll or latest deed) If. applicant is a corporation; signature of duly authorized officer. (Name and title of corpo?ate officer) ' Builder's License No ..... .~-~'~l .~ ' Plumber's License No ......................... Electrician's License No ....................... Ct er Trade s hcense No ...................... 1. Location of land on which proposed work will be done .................................................. ' House Num her Street Hamlet County Tax Map No. 1000 Section .. It1,~ ..... mock ..{ .......... ' Lot .~ ~.~ .~ ......... ......... No. ot. ........ 2: Stat~ existing use and occupancy of premises and intended~se and o~cupancy of proposed construction: a. Existing Use and occupancy ....} .......... · .......................... ~~'~.;1.i ............ o. lntenaea Use and occuvancv . }~.~.~.. ~.~ F o r~c, ta~ ~ ~a~d,~~,~i'~.''~ .3. Nature of work (check wl~ich a!pplicable): New Building Addition Alto ................... ration . . ' R pmr .............. Ren~oval ............. ~ Demolitio! ,. .... ; ......... Other Work .~a*~..~ ..... 4. Estimated Cost . .~ ~.~. · .~N)...' ..... i (Description) i (to b,v ' ..... 5. If dwelling, number of dwelling! .... Number of dwelling units on each floor ....... ~ units .......... ,. , ......... · Ifgarage, number of cars ...~ ... ' 6. If business, commercial or m DC n y specify nature and extent of each type of use ..... ' ............ 7. Dimensions of existing structuris if any: Front Rear ' Depth Height Numb'er of Stories ............................................. Dimensions of shine structure w~th alterations or additions: Front : ~D.epth .Height ................. Rear ...... i ......... '. ....7 ': .......... i ............. ' ........ :.. Number of Stories .......... '. 8. u~menmons oz entire new construction: Front ' ' ~ .... Height ~."~,{~ [t~2JN~ Number of Stories ~ ........... ....... ...' Depth .... . ......... % Size of 10t: Front ........ i .. ' ~.. Rear. (4~O '' ' ........................... Depth .................. .,1~, tut~ htck " 1 0. Date of Purchase ..... I ........ ' ......... Name of Former Owner ..... ~. e,... 1 1. Zone or use district in which primises are situated ............. ' .......................... ~, .' 12. Does proposed construction violate any zoning law, ordinance or regulation: . .~.~...' .................... Will 10t be re reded J~l~. . · · 13. g ...... ~. · ~ ................ Will excess fill be removed from premises: Ye No 't4. Nam e o f Owner o f premises i~ ~[1811[~.~1~. .... Address :... . ..... Phone No. ~ ~.*..~..~.~,.... Name of Architect .......... I ........ .......... Address ........... ........ Phone No. .. Name of Contractor ........ : · · ~ ................. Address ......... ; ...... Phone NO ....... ' 15. Is this property within 300 feet of a tidal 'wetland? *Yes ........ No...~... ' ........ · *If yes,'Southold ~own Trustees Permit may be required. · '' · PLOT DIAGRAM . Locate clearly and distinctly all ibuildings, whether existing or pi'oposed, and, indicate all set-back dimensions from property lines. Give street and block number or description accordind to deed and show -*---' .......... interior or corner lot, ~ o , ~.~ muu~ anu lnmcate wnemer STATE OF NEW.YO.Rff, . COUNIY OF ,~q'~/5-.'.'.'.'.'.'.'.~'.4; .tS".. ~.. (Name of individual signingicontract) ~bove named· ~ 7fl5-1802 '9 A~ TO 4-PM F~R TH,: . FOt~ POlJf~[!O CONCH~T~' { ' 3 ~NSUtATff)N 'vv r 4 FINAL = CONS~tUC?IO0 MUST BE COMPLETE FO~ C.O. ~ ~I..L CONSTRUCTION SHAL~ MEET TFI~ REQUIREMENTS OF TRE N.~ S~AT~ CONSTRUCTION & ~NERGY CODES. NOT RESPONSIBL~ FOR DESIGN OR CONSTRUCTION ERRORS .... being duly sworn, depose~ and says that he is the applicant (c i~ ) ................... I ontractor, agent, cdr orate officer, etc. ' )f said owner or owners, and is duly at~th, orized to perform or hay6 performed the.said work and to'm~e and file~this ~pplication; that all statements containe~t in this'application are t'fue tO the best of his knowledge and behef and that the a'ork will' be performed in the manner se~ forth in the application filed therewith. ' ' ;worn to before me thi.s · day of ' 19 4' ' '' ~..., ........ County