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Home My WebLink About22858-z FORM 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) 22858 Z pursuant ,o application dated ............... ~~...,../...¢.,, 19..¢~nd approved bythe Building Inspeotor.,,,~ Fee $....../, ........... ~ Rev. 6/30/80 FORM TOWN Of: SOUTHOLD BUILDING DEPARTMENT TOWN ItALL SOUTHOLD, N.Y. 11971 19 · TEL.: Of' IIEALTII SURV£Y ............. v/CIIECK ......... ~ .... SEPTIC FORH .............. CALL ........... HAIL TO: l)isapproved' a/c ............................. , ' (Buildi ~g I ~spector) . · . / I · ~P~LICATION FOR BUILDING PERMIT ' ' ' INSTRUCTIONS · a. This application must be completely filled in by typewriter or in ink and submitted to tho Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acco[ding to schedule. b. Plot plan showing 19cafion of lot and of buildings on premises, relafionship 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- catiou. 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 shall be kept on the premises available for iuspection throngbout the work. e. No buikiiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted I)y the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Deparhnm~t for the Jssuauce of a Building Permit pursuant to the Building Zone Ordiuance of the Town of Soutlmld, Suffolk County, New York, and otb, er applicab e Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal ~!r demolition, as herein described. The applicant agrees to comply with all applicable law~, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .... (~i~nature of applicant', or name, if a corporation) ~ ' (Mailing address of applidant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder· (as on the tax roll or latest deed) If applicant is a corporation, signature of duly antborized officer,' (Name and title of corporate officer) Ihdkler's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No... .................... Location of hind on wldch proposed work will be done ................................. : ................ . . . . , ...... .. .z. . . ./?. ....... '. .... :V: ..... llouse Number Street ltamleI cotmty Tax Map No. I000 Section .4~7. .......... Block ..... ~.~... :... Lot Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) Slate existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ., ~z~¢~/(~ 0/~ ~ ,~:~ 'd'& /" , Z: Repair .............. Rempval .............. Demolition ·: ......... Other Work ............... 4. Eshmate Cost. . ;. , (to be paid on filing this applicatioo) 5. If dwelling, nnmber of dwelhngunits ..... / ......... fiumber of dwelli ~g umts on each floor., ff ..... If garage number of c~s A/'C~ ' ...... 6. If business, commercml or m~xe~ occupancy specify natore and extent of.eac}l type et u~e ...~.. 7. DI ne Is oils el existing structures, ff a ly Front...~ .......... Rear . .~.~.~... Depth .~.~ .... lleight ~ Numbel of Stones / ' ' of~' ' ' ~, Dnnenslons nme stmotu~e w~th allemhons or ~ddltlons: Fronl ~. ............ Rear ....... Depth ................. i.. Height .... Number of Stories.. d ' ' 8. DImensmns of entire new cons chon' F~t ~e ~e~ ~ ~ Depth .. - 'gl ' ' . . ~ . Y' ........ .llei ~t ............ ~.. Number of Storms... ~ ......... ' t 5 ~ .. · , ,z~ ................ 9. S ze of et' Fron '~ ........ ' ....... ; ......... 10. Date of Purclmse ... ~ .' .... Name of Fenner Owner . <'. . 11 Zon~ or use district in which pr~ roses are situated )2. Does proposed constrnctmn violate any zoning law, ordinance or regulation: ...~e .......................... 13. Wi et be regraded ~ ' ~ . . tf yes~ Sou~hotd Town trustees Permt~ may. be required. ' ". i P~OTDIAGR~ Locate clearly and distioctly all~buiMings, Whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~ tuber or descnphon according to deed, and show street names and indicate wheflmr interior or comer lot. STATE OV NEW YQ-!,~K.., ~ ~ S cou r3'¥ ..... ,' ,,. ~/~Z ~.. h/~/~q ..................... being auly sworn, deposes and says ti,at he is the applicant (Name of' ~dividual s~gm ~g contract) ' above nallled. (Cootraetor agent cor'porate officer ere ) of said owner or owners, and is duly} attthorized to perform or have performed the said work and to make mid file tiffs application; that all statements conlaihed in flfis'npplieation ar~ (rue to the best of his knowledge aod belief; and that the work wffl be performed in th nner,sel forth m tim a Ilea ' Swonl .... Ii~ · pp tion flied therewith. tooemren, etlus /./ , ' X_ , ' ' ~o. 47~1~ C;~'~ ' .' ~ (Signature of applicant) Term Ex~if~ May 31