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Home My WebLink About22727-zFO~M NG.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FHLL COMPLE~ION OF THE WORK AUTHORIZED) Dot~ .................................................. 22727 Z Permission Is hereby grc~t~ed3to: .................................... Coun~/Tax Map No. 1000 Section ....... ~..,.~... ...... Block ......... ~ ......... .. LotNo ........ .~,....~....~....~..... pursuant to application dated ........~ ....................................... 19 .~. ~.~ and approved bythe Building Inspec.~tor. ~ Rev. 6/30/80 Examined ............. , I9.. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ........... I ermit No. Disapproved a/c ..................................... ': ~ f 2 ~ i~ (Buqlding~"fispector) ~ I APPLICATION FOR BUILDING'PERMIT g~,\gD~OF HEALTH 3 SETS OF PLANs ......... SURVEY .................. SEPTIC ...... -7 ... c^ L . ..¢ .... HAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 sfi'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applL cation. .. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will igsued a Building Permit to the applicant. Such permit sh',[ll 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 Occupancy sh~I1 have been granted ~?y 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 South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descrJbbd. The applicant agrees to comply with all applicable taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~~ .. · -- (Signature of applicant, or'name, if a corporation) ... < (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of premises ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No. h · Ot er Trade s L cense No. 1. Location of land on which proposed work will be done ................................. ~ ................ House Number . Street Hamlet Cou'nty Tax Map No. 1000 Section ....' ....... . ..... Block ........ ' Lot ..... ,x ..... Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) 2: State existing use and occupBncy of premises and intended use and occupancy of proposed construction': a. Existing use and occupancy ....................... ' ........... i.. .3, Nature of work (check which aPpli,--u, ........... ' , . ' ' n~ ,,,,o,~). r~ew J~uualng .......... Addition .......... Alteration .... Repmr ....... Re oval .............. ,Demolition . ./~.~',¢k'..~?. '" , / , ~ .., ,, · .............. Other Work.. . . ~ 3 ?. ?.', ~ (Description) 4 Estimated Cost . filing this pplic ti n) ' ' (to be paid on a a o 5 lfd elling numberofdwellin~units Nurhber6fdwelli lfgarag numbe of .............. ' ngunits on each floor If business, commercial or mix'ed occupancy specify nature and extent of 7 Dimensions el existing strucWfes if any: FrOnt ........ · .each type of use Height N~ ............. Rear Depth umber of Stories ' ' '" ....................... ............... with alterations ................................... Dimensions of shine structure ' ' ' or additions: Front .................... Depth ' ' Height ................................ . . Rear ........................ ' ~ Number of Stories ' zmensions of entire new construction: Front ............... ./~..'~/?.'. Number of Stories . Rear Depth Height ............................................ fl6t . 9. Size o : Front ' Rear. Depth ...... I0. Date of Purchase .......... i ............ Name of Former Owner Zone or use &strict in wh. ich premises are mtuated ............ ' ........ . 12 Does proposed construction vic'late any zoning law ' ' 13 Will 16t be regraded ~ , ordinance or regulation: · · ....... , ................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' ·. ' ...... , ........ Address ......... . .......... Phone No . Name of Architect .' ................. Name of Contractor .......................... Address ................... Phone No ............ : .... Address Phon~ No ' ).5 ' Is this property ........ 2,'0'0 ...... ~'f ............................ .............. within feet tidal 'wetland? *Yes No · If yes,,'Southold Town Trustees Permit be requirg~ ............... , may. . ... !' PLOT DIAGRAM Locate clearly and distinctly all! buildings, v~heth~r existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or desoriptio~ a~cording to deed, and show street names and indicate whether interior or corner lot. . .~ , . ~:OLL()WI~,!G ~NSFECTIOMS: FOR POURED CONCRETE' ? ,<OJGH - FRAMING & PLuMo~NG 4. ~: NAL, CONSTF{UCTff)N MUST ALL CONST~UCT~Oh~ SH d,L MEET 'r~¢~ REQUIREMENTS OF 'rHE~ a,Y. ST~FE CONSTRUCTION & ENERGY ,L,(,DES. NOT ESPONSIBLE ~ FOR . ~>~{a~¢~J o~ CONSTmJc'rlo~ ERRORS rATE OF'NE~ORI~,/-' // ...... /'~:~'5' "' ~' ~"~.(~.'. ...... being ~uly sworn, deposes =d says that he is the applicant (Name of individual signing contract) )eve named. , ' the ~ (Contractor agent corporate officer etc) ............... ' said owner or owners, ~d is duly ~ut~o~zed to perfom or have perfomed the said work and to m~e and file this plication; that all statements contained ~ this'application are {rue to tt~e best of his knowledge and belief; and that the )rk w~l' be perfo~ed in the manner sdt forth in the applicMi6n filed therewith. ' yom to before me th~. ~IARY PU$L C, State of N~ Yet8 ' " .~-~.~-f~ 72;. 7 ...... ~~ ......... No 4879505 , ' i ' ' ' · ' (S gnature ofapphc~t) , ~mmission