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Home My WebLink About22966-zTOWN OF $OUTHOLD BUILDING D~:PARTMENI' TOWN HN.L SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE~ON OF THE '~DRK AUTHORIZED) N? ~)2966 Z Date ........ ~--~..,.~., ,,~,., ................... Permission Is hereby granted to: ,,~ ........ ......................... at premises located af ........... ./.....~..~..,..... ~~,, .~ ................................................... Coun~TaxMapNo, ]000 Section ........ ./. .............. Block ....... ~,. ................ LotNo. ,/~',,,.'~'... .................. Building Inspector, ............................ ~'~i;~i,7;~u;'~"~ ............ Rev. 6130/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT.. TOWN HALL SOUTHOLD, N.Y. 11971 /Q / TEL.: 765-1802 Approved . I tNo...~, .~ffI. IC~TION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HE^LTIt ....... 3 SETS OF PLANS ....... SURVEY CHECK ................. SEPTIC FORH ........... HAIL TO: * a. Tiffs apl~lication 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 scliedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public s6'ee or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of tliis app cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Sucli perm shall be kept on the premises available for inspection tliroughout the work. e. No building sliall be occupied or used in wliole or in p~t for any purpose whatever until a Certificate of Occupanc shall liave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tb Building Zone Ordinande of the Town of South01d, Suffolk County, New York, and otlier applicable Laws, Ordinances { Regulations, for the construction of buildings, additions or alterations, or fqr removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whetlier applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or buLider (as on the tax roll or latest If applicant is a corporation, signature of duly authorized officer FOLLOw~NG765'1802 9 INSPE~T~ .............................................. ~. FOUNDAT~O~ (Name and title of corporate of~cer) ~OR POU~E~ /~ , OUCH. FRA~,;)NG & PLUMBIN Builder's License No .... ~, .~. . ~. ~ 3. INSULATIO~ 4. FINAL CO~ST~UCTION. MUS Plumber's License No ......................... ' BE COMPLETE' FOR C.O. ALL COnSTRUcTIoN .... THE REOUIR~E~I$ OF ~E N.~ Electrmmn s Lmense No ....................... STATE CONSTRucTION & ENERGI Other Trade's License No ...................... CODES. N~ RESPONSIBLE FO~ , ~ESIGN OR CONSTRU~N I Location of land on which proposed work will be done.. ~ .... ~ .~ ilouse Number Street Hamlet ' Filed Map No. Lot Subdivision ........ . .................................................... (Name) 2: Statd existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... 3. Nature of work (check which applicable): New Building . ] ........ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .... : ......... Other Work. ~..~..~.. ~:.. 4. Estimated C .......................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... . Number of dwelting units on each floor ................ · If garage, number of cars ........................................................................ 6. If business, commercial or mi.>~ed occupancy, specify nat,_ur.e an~,d e>'aent of,each tyl2e o~u~se . 7. Dimensions of existing structures, irany: Front ...... Rear., Height ............... Number of Stories ........................................................ Dimensions of shme structure with alterations or additions: Front ................. Rear .................. Depth .... '. .................. Height ........... ' ........ ,., Number of Stories ........... 2 .......... 8, Dimensions of entire new construction: Front .............. ; Rear ............... Depth ............... Height ............... Number of Stories ....................... , ................................ 9. Size of lot: Front ......... , ............ Rear ...................... Depth i0. Date of Purchase .................... · ......... Name of Former Owner ............................. 1 1, Zone or use district in which premises are situated ....... . ................... ... ........................ 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will 10t be regraded ....... ', .................... Will excess fill be re~mvcd from oremises: Yes No Name of Architect ........................... Address ................... Phone No. ,/. .............. Naine oi' Contractor .......................... Address ................... Phone No ................ I~s th~.s property within 300 l~eet: of a tidal wetland? *Yes ........ No ......... · L£ yes, Sout:hold Torn Trustees Permit may. be requi_red. PLOT DIAG P,.AM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ;TATE OF NEW YJ~RK-~ ~, . ...... ~:~.C,~... '.. ~~.. ......... being duly sworn, deposes aid says tliat he is the (~ne of individual signing contract) bore named. is the ' ' ......................... "· - (Con gent, cor¢orate officer, etc.) said owner or owners, ~d is duly authorized to perfo~ or have perfo~ed the said work and to m~e and file this pplication; that all statements contained ~ this application are true to the best of his ~owledge and belief; and tibet the ,ark w~l be perfo~ed in the m~ner set forth ~ the application flied therewith. worn to before me this rate, Public, ...,~~~" ~'n~~ . t . ~ ~ ~ ~. ~ N.Y, , ' (Signature of applicant)