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Home My WebLink About22802-zFODM TOWN OF $OUTHOLD BUiLdING DEPARIMEN'~ TOWN HALL $OUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMff MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22802 Z Permission Is hereby grante¢.~: ..... ~o.,~ ........ ..g....:....~¢ ................... ..... ./....~,.....~ ....... ./.~ ............... (._ .................. ...... .~.~..~.........~..¢.: ........ .... ~.~.=.~... ......... ~ ...... ../..~...~ .................. ~. ................................................................ ~,.,.~, ............ ~,/,,.....,,x,~.....~~.....,,,/,,,,.~,,,. .......... .../,.~ ......... ~,.F,-.. .......... ...~/~? ........... z~...~ .............. ~ ......... ~/.~ ........ ~.: ........ ~~ ........................ at premises located at ............. .'~...~ ......... ~/../~..../~,~ ..,~,....O~..t ............................... CountyTax Map No. 1000 Section '~'-~ Block pursuant to application dated ,..~//9 19 ¢,-'~'"" and approved by the Building Inspector. Fee $ ...... ,.~,.,.~,.'..~ .... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 ~.~ BLDG. D EPi,I. ,i ~OWN OF .q~O. UTdO!.:P ......... ~ TEL,: 765-1802 Examined ..... .~'~. '/.~. .... ,19~ ' ' · . .~'~/~ ...... l g~ermitNo. Approved Disapproved a/c ................ ' · (Bja'rll$i'flg Inspector) APPLICATION FOR BUILDING' PERMIT BbARD OF HEALTH SETS OF PLAb~q ~SURVEY ................. ~CHECK .... NOT! FY ~ CALL /' V' ' zex jJ'fi ....... ..... Date · 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink an'd submitted to the Building Inspector, with 2 sets of plans, accurate pict 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'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 igsued a Building Permit to the applicant. Such permit s~hall 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 shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department'for the issuance of a Bu/Iding Permit pursuant to the Building Zone Ordinance of the Town of Southold, 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 described. The applicant agrees to comply with all applicable laws, ordinances, b~ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signatur9 of applicant, or name, if a corpo~'ation) 0 (Mailing address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, generai contract¢~r, elect,rg~i[~ ,p~!:~..ber or. bu'ilder. Name of owne; of pre nises, ff--O.O Y~./~"/~ ~'7 .~- · .'~'-'~5;~ ;/? ' ' i ....... ' ' i~i~ ii'i0~ ....... :' ......... (as o~ the ;ax'to'l; ;r ' If applicant is a corporation, signature of duly authorized officer. FEE-* ~'*~*;'' ~ B~: ~O~:5~'~ -. NOTIFY BUILDING DEPARTMENT AT (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ........ / Other Trade's License No ...................... 785-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ' TWO REQUIRED' 2. ROUGH - FRAMING, & I~-UMBING 3. INSULATION 4. FINAL o CONSTRUCTION' MUST ' BE COMPLETE FOR C..O.' · ALL CONSTRUCTION 8HALL MEET THE. REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES..NOT RESPO#$1SI.~ ,*Oa Location of land on which proposed work will be done ........... DESIGN OR ~ ,I~. UCllON, ERR~ ........ ~ ~i:~! ........ ~'' t "' ' ....... .... x,.. ............. House Nmnber Street Hamlet Cou'nty Tax Map No. 1000 Section ...: ~.~ ......... Block ....... ~ · · · ' Lot ................ Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ,~..S'. ~' D.~/~/dT.~' ................................ b. Intended use and occupancy .. ' .. ~Io~ . ' .," ~ . 3. Nature of work (check which a plicable): New Building .......... Addition .......... Alteration .... ~.. '. ........ "' Repair ...... Rem vel .............. Demolition .. ............ Other Wqrk,. ', ~' (D~cription) 4. Estimated Cost ........... ~'"~ '~' Fee ~ (to be paid on filing this application) 5. If dwe ling, number of dwelling hnits .............. Number of dwelling units on each floor ................ · If garage, hum her of cars ..... ! ............. ...... ' ............. . ............. .. ' 0 ify t'o'f e'oi ,i iiii 6 If business, commercial or mi.xe occupancy spec natur~ and exten .ea ty e .... Height .. ,Z.57.~ ........ Num!ber of Stories / · pth .......... , !th ~..~.',r'~:'~ i I~ear'i 'i "i[i ........ D:mensmns of same structure ~v~ alterations or additions: Front ...... pth ' De .... ' ........... . Height ., ... . ~ ....... .................. ... Number of Stories ............ tm .......... 8. Dimensions of entire new cons ction: Front. , ' Rear .... De ..,- .... .......................... pth ... Height ............... Number of Stori 9. Size of lot Front ~ . es .~. ..................... , .............................. · · ·: · ~ .......... ~ear .................. Depth ......... 10. Date of Purchase ........... ~ ........ . ......... Name of Fo'r~e'r Owner'... ' ........... 11. Zoneorusedistrictinwllichpremisesaresituated . . :!i ............. : ....... 12. oes proposed construction violate any zoning law, ordinance or regulation: ... 13. Will 16t be regraded ........................ 14 N ......... ; ............ Will excess fill be removed from premises: N . ame of Owner of premises ... ..... Add Yes o N f A hiti~ ........ ; ........ ress ............ Phone No .......... . ' Add ...... ame o re ct ......... , ......... ' ...... Name of Cent ......... ress ............... Phone No .......... rector .... , .... · .: .... Add Ph N ' · ' ty ...... ' ................ tess ............. . ...... one o ............. ,.. 300 ' d? 15 I.s this proper within feet of a tidal wetlan *Yes ........ No ......... ' *If yes,'Southold T~wn Trustees Permit may. be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, v~heth~r existing or proposed, and, indicat~ all set-back dimensions frqm property lines. Give street and block nilmber or description according to interior or corner lot. deed, and show street names and indicate whethhr TArE OF.NEW ~R.K~ ou .¥ OF... .... ~. · · . · · .' .... being duly sworn, depose~ and says that he ~s the apphcant "' ~; :'(Na~e, of,indiv~ ~,~s~ ' ' :,.... ................ O ........ ............... (Contractor agent corporate officer et~ ~ .............. ' .............. said owner or owners, ~d is duly au}liohzed to perfo~ or have perfomed the said work and to m~e and file this plication; that all statements contained[ ~ this'application are true to the best of his knowledge and belief; and that the ~rk will' be perfomed in the manner set, 'orth in the applicati6n filed therewith.' /om to before me ~ ¢(..I1~ L. GL[W' , NOTARY PUBLIC, Stale of N~ York No. 4879505 ~ ~/ _ Oualif~d n Suffoik. Coun~ ~/( mmmi~ion Expires O~ember q, l~ . "..&..~. Cou!ty '