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Home My WebLink About22728-zFORM NO,$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Dote ..,,..~. ,~., .~..,~ .............................................. 19 .~..~ 22728 Z CounlyTClX Map No. 1000 Seotlon...~..,'-~,, ,~.. .......... Block ............ ..~--~........ Lot No ........... ../.......~.... ..... pursuant to application dated ..........................................................19 ................ and approved bythe Building Inspector. Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM ENT~ TOWN HALL SOUTHOLD, N.Y. 11975 ../ TEL.: 765-1802 Examined ...... ,19~. ' ' . Approved. · ...... 19,~emlit No .~..2, .7..~..~.. DisapProved· a/c .... · BLDG. DEpI ...... TOV'm OF $og~'}~ot i) INSTRUCTIONS 3 $'ET$ OF PLANS ........ SURVEY ................. CIIECK SEPTIC ..... HAIL Date ' · 19 (as on the tax roi1 or latest deed) ............ If applic.~¢t is a corporation, signature of duly authorized officer.' . · ( amc and title of corporat~fficer) ' ' ' Builder's License No ............ ' Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... .. , . , Location of land on which proposed work will be 'done ....... ' ...................................... House Number ~' .............. Street Hamlet Cou ty Tax Map No. lO00 Section . . .; .... . ..... Block ...... Lot ..... Subdivision , ........ . .............. ; .... .......... Flied Map No (Name) . '. ............. Lot ............... Stat~ existing use and occupancy of prom scs and inrteaded use and occup~an,cy of proposed construciio'n: , · a. Ex sting Use and occupancy ... . .......... · . , b. lnten~ed use and occupancy . ' f/' ..~../.~ ~ J~,.'"~'~,;~k ' ~ t/ .... building for ne6essarv insp, ectio~s ,.. ...... (Signatur~ of applicant, or name, if a corporation) .'. · (Mailing address of applicant),/ is owner, lessee, 'agent, architect, engineer, generai.'contractor, electrician, plumber or builder. State whether applicant a. This application must be completely filled in by typewriter erin ink arfd submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plin showing location of lot and of 6uildings on premises, relationship to adjoining premises or public sti'eet or areas, and giving a detailed descriptioh of layout of property mu~t be drawn on the diagram which is part of this appk ¢. ' The work covered by this application may n~t be commenced before issuance of Building Permit. . d. Ui~on approval of this application, the. Building Inspector v~lil issued a Building Permit to the applicant. Such permi 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 Occupanc. shall have been granted t.,y the Building Inspector. . .. APPLICATION IS HEREBY MADE to the Building DepartmeJt fro' the issuance of a Building Permit pursuant to th Building Zone Ordihance of the Town of South61d, 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 hereih described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t.' admit authorized inspectors on premises and in '3. Nature of work (check wh. ich !applicab e) Repair .............. Retrieval New Building . ~.. i; .... on .......... Alterat · ..h. · i, (Description) (to be paid on filing this application) 5. If dwelling, number ofdwellin' units'.,........ Nurhber o"~'~ dwelling' units' on each floor ................ · If gara, ge, number of cars ... ............................ ................................. , .... 6. If, business, comm, ercial or mi~ed occupancy, specify nature and extent of,each type of use .................... 7. Dimensions of existing structures, if any: Front ....... ; ....... Rear ........ Depth .............. H.eight ............... Nu!mber of Stories ..... ', .......... ' .... ' .... ' ........................... Dimensions of shine structure !vith alterations or additions: Front ......... ReJr ...... : Depth .... ~ ,. Hei~.t ..... ' ....... ' , ' ...... .... ~ .... , .......... ,.; mumoer olatones ........... ; , 8. l~,imanmons el entire new cons:truction: Front .............. ~ Rear ........ Depth ..... 1121111 Height ' Nu:mber of Stories 9 Size ofl6t: Front ' ' ' Rear ' ' .......... ~ ..................................... Depth 10 Date of Purchase " ' ........ · · ~ .................. .. Name of Former Owner ..... 11. Zone or use district in which p'remises are situated ' ' ' , 12 Does proposed c .... ordinance or regulation: ' . onstruction w01ate any zoning law ' 13 Will I6t be regraded ' ' Will excess fill be removed from premises: Yes ........ ;i .................... No 14 Name of Owner of premises Address Phone No Nb. me of Architect i " Address Phone No Name of Contractor ' Address ' Phone No .' :r thi ............. '~ ...... f .... A~' ~ ' t~ ' 'g? ................................ 15 ,s s property within!300 eat o a a we an *Yes ........ No ......... · If yes, SoutholdlTown Trustees Permit may be required. PLOT D[AGRAM Locate clearly and distinctly al buildings, v~hethgr existing or proposed, and, indicate ali set-back dimensions from property lines. Give street and blocl4 number or description according to deed, and show street names and indicate Whether interior or corner lot. STATE OF NEW~.Y.~O~z. ,) l COUNTY OF..1:~..... ~P...~'"'~%..... "P'S '- -- ~'""~ --t,x',.,.x~:.~..m.~,....-v~.:...e-.~-. ......! .'74'...~.: ....... (Name of individual mgnrng contract) ~bove named· being duly sworn, depose,s and says that he is the applicant is the..~ .... (Contractor, agent, corporate' officer' , etc.) ........................... said owner or owners, and is duls, authorized to perform or have performed the said work and to make and file this ~pplication; that ali statements contalned in th's'apphcation are t'rue to the best of his knowledge and belief; and that the a'ork will' be performed in the manner, set forth in the application filed therewith. ' iwom to before me this ~ ........ .... l.~,' ..... .~..d~y ~. ~t:?..C!..~... '....., igq.D No. 4942668, Suffolk Coupt~, ...................................... Term F..xptres October $,. 19:::::~,M9 ' (Signature of applicant)