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Home My WebLink About22782-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ~"'/"~'~ 9f 22782 Z "7-'- ................................................. Permission is hereby gr~nted to: /~ // ,,,2 /'~ /" ~' .'~//~. ~;~'"'~'T'7'"~'. C7;~';~ ............................... ~.~~ ...... ~.....~~%..~~ .......................................... at premises I~at~ at ........ ~~.(~~~ ~~ ........................................................ .................................................. ~~..,..~~ ........ , ..................................... Coun~Tax Map No. 1000 Section ........ ~ ......... Block .................. ;~... Lot No ........ ~ ............ pursuant to application dated ....,~ ....................................... Building Inspector. Fee S.~"~..~... 19..~..~..., and approved by the Rev. 6/30/80 ,/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL OUTHOU . N.Y. , .~, .~.~, ~"~'~"' TEL.: 765-1802 Examined ........ 19 .,,pprovcd..V/a/. ........ lq.57Permit No Zg' . Disapproved a/c ..................................... APPLICATION FOF~BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ........ ~ ............ CHECK ...................... SEPTIC FORM ................ NOTIFY~ CALL Date ty T 1000 S I O · .~. ,5. Court ax Map No. ection .................. · Block ....... . . · ........ Eot- . .... " Subdivision Eiled [,lap No '- Lot (Name) · · State existing use and occupancy of premises and intended use and occupancy of proposed constroction: A. Existing use and occupancy.i.I f.r; ..... ~ ..... :..*..~. .... ~.~.~.,,;~.,~.: ............. B. Intended use and occupancy....~...~~.~'.,.:!i?;!:':?.,~,Jf, '. ..... .'' if applicant is a corporation, signature of duly authorized officer. ....... .......... ( arr~and titI~ ofcorp~ate officer) · · Bu lder s L No ...................... COniC Plumber's Lkcnsc No HfcctHcfan's Lfccns~ No ..... Ofl~cr T~adc's Lkcnsc No. /~ Location ofhnd on whkh p~oposcd work will bc done: House Number Street, Hamlet % INSTRUCTIONS a. This application must be completely filled in by typewriter orin ink and submitted to the Bmldtng Inspector, with sets of plans, acourate plot plan tOo,~cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of l&yout of property must be drawn on the diagram which is part of th.is appli- cation ¢. 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. Suer permit shall be kept on the premises available for inspection througlaout the work. c. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted'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 S0'uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bufldhqgs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all pphcable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary inspections. · . Si-nature 6f'a;r; ' ' -. ........ , .... ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ' ..... e' t'a}' ;o'li ;; ia't'~;t' ~i; e'd') ......... 5. Nature'ofwork (check which applicable): New Building .......... Addition .......... Alteration ........... Repair .............. Rbmoval! .............. Demolition .............. Swimraing pool ............ Tennis Court ....... ~ AcCessory Buildlng .......... Fehee .,e~ .... Other Work ............ ~. ~imated Cost../~.a...--m..... I ...................... Fee...~C,.~.~.. ..................... .. ,i "~ (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units on each floor ......... Ifgarae:e._ numberofcars ....... i ............................................................. · ... ~. If business, commercial or mixed o~cupancy, specify nature and extent of each type of use ..................... . ?. Dimensions of existing structures, if any: Front .............. Rear . . Depth Dimensions of same structure with ~lterations or additions: Front ................. Rear .... Depth ...................... Height ...................... Num bet of Stories ..................... . ~3. Dimensionsof entire new construction: Front .... q/~2~ ...... :~:~ ...... i ........ Depth ....... Height ...~,~ ........ Numbe~ of Stories ............................ ........... , ........ Rea .................. Depth .. . 3. Date of Purchase ............. } ............... Name of Former Owner ............................. I Zone or use district in ;vhich premises are situated ' 2. Does proposed construction violat~any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded ........... ; ................ Will excess fill be removed from premises: Yes .... No.. 4 Name of Owner of premises ~ ' Address Phone No Name of Architect I Address Phone No Name of Contractor ' Address Phone No ' ;5.I$ this property loc~te~ within 300 feet of a tidal wetland? mYgS .... NO .... mil yes, Southold Town T, rustees Permit may be required. : PLOT DIAGRAM Locate clearly and distinctly.all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block nut tber or description according to deed, and show street names and indicate whether ~tefior or corner lot. FOLLOWING 1. FOUNDATION - '~NC) REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMB)NG B~ COMPLET~ FOR ALL CONSTRUCTION SHALL ~gEET 'THE R~OtIIREMENTS OF THE STATE CONSTRUCTION & ENERGY COD~S. NOT RESPONSIBLE FOR D[SIG~ OR CoNSTRUCtION ERRORS ;TATE OF NEW,YORK, ~, io U,~T~' oj~ ~ ..... ~'~ ..... , ................. being duly s~vorn, deposes and says that he is the applicant , ?'(Name ofindividualCdgning :ontract) bore named. (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly at thorized to perform or have performed the said work and to m~e and file this pplication; that all statements contained in this application are ~true to the best of his knowledge and belief; and that t~e turk will be peffommd in the m~ner scl forth in the application filed therewith. ,worn Io before me this . ............ ~ ........ a~v or...~..Zz/.~... ~.., ~9 .~ ' i ,o,~,v ,u~[,,, ,m vo~ sm~ ~. ..... ,o. ~0~0~0,~, ' ' "; ~r~' 'r ~UALIFI~D IN SUFFOLK OOUNTY-- ~ (S~.narure pp