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Home My WebLink About22886-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] ~o,~ '. ......... ..?/.../..~ .................. ~ 22886 Z Permission Is hereby granted to: ~~ ~ .... ~,~ ............... ...... ~..-~~: ..... ..:..~ · . .... :.~.-~.~.~ ........... ~ ............ ~ to.,..~..-:.,......~. ........ ~.-~......~-,~., .......... ~ ........ ~~....../...~ ......... ...... /~.z~...,..: ........... ../.~ ............. ~..~.... .......... ~ ............ ~...~.J ......................... ..... ~....,,:... ............. ~,.>,.~ ............. ~ ............................................................................ CouniyTax Map No, 1000 Sectlon.,,..~.,,~,..~',. ........ Block ........ ~./..; ...... LotNo ........ ,~. ............... pursuant to application dated ............... . .~.//.~/...~.. ........................ 19.... ,~,.~ and approved bythe Building Inspector, Fee $..,.~..~..~.'~.. ...... Rev. 6/30/80 ~ FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN IIALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exa,uined ....... .~.~.,/. 77...., 19 .?,.~ ' Disapproved' a/c ................................ : .... BOARO OF HEALTll ......... 3 SE1;S OF PLAaS SURVEY CHECK 1~ O IH'I SEPTIC ........ : .......... CALL ......... . · HAIL TO: State whether applicant is owner, lessee, agent~ architect, engineer, generai contractor, electrician, plumber or builder. ........... ' Name of owner of premises . (as on the tax roll or latest deed) " APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO. 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ~ 2, ROUGH - FRAMING, & PLUMBING 3. INSULATION 4.FINAL - CONS,TRU~TION MuST BE COMPLETE FOR C.O. Locationofl ' , , , f.,. ,,, . [ ALL CONSTRUCTION SHALL MEET 1. aha on which proposed work will be done ~(7~ .......................... NERGY ~..~7 ' "-7 ~'"~- ' , STATE CONST'R'dd'frbhf'~'t .... ....... ' ....................... [ ..... CODES· NOT RESPONSIBLE FOR ' Comity Tax Map No. ,000 Section .... '.[ .~..~. .... Block ..... Subdivision Filed Map No.~ .............. L&.. :'...; ........ (Name) 2: Slate ex/stiug use and occupancy of premises and intended use aud oc'cupancy of proposed construction: a. Existing use and occupancy ., ' r? *'tt~'~" ~T~'~¢~ ~q b. Intended use and occupancy . r ~ t If applicant is a corporatioq, signature of duly authorized officer. (Name and title of corporale officer) Builder's Liceose No .......................... Plmnber's License No ....... ' .................. Electrician's License No ....................... Olher Trade's License No ...................... (Signature of.q~plicant, or name, if a corporation) ' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 21 · sets of plans, accurate plot plgn to scale. Fee according to schedule. b. Plot plan showing 19cation of lot and of Imildings on premises, relatignship to adjoining premises or public sti'eets or areas, and giving a detailed description of layout of property mu~t 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 i~sued a Building Pemrit to the applicant. Such permit shall be kept on the premises available for inspection throogbout tile work. e. No building shall be occupied or used in whole or in part for any pu/imse whatever nntil a Certificate of Occupancy sball bare been granted I~y the Building Inspector. APPLICATION IS HEREBY MADE to tile Building Department i'or tile issuauce of a Building Permit pursuant to the Buildiug Zone Ordiuance of the Town of Soutlmld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal ~tr demolition as herein descr b~d The applicant agrees to comply with all applicable law~, ordinances, buik ing code, bousiug code, and regulations, and to attmit authorized inspectors on premises and in building for necessary'inspections. (D iptio ) 4. Estimated Cost ................. Fee ................................... ] (to be paid on filing this application) · ~ ' ....~.. Nulhber of dwelling units on each floor .. ~ ........... $. If dwelling, number of dwelhng .units ........ .,. . · If garage, number of cars ..... I .............. , ................................................... 6. If business, commercial or mi.xed occupancy, specify natorc and exle,t of each type of use .................... 7. Dbnensions of existing stmctur{s, if any: Front ..... . .......... Rear ............... Depth .............. Height ............... Nuniber of Stories ... 1.11 ................................................. Dimensions ?f shine structur, e wlth alterations or additions: Front ................. Rear ..... . .......... Depth ..................... !.. lleigbt .......... : ........ .,., Number of Stories ................... 8. l)imensions of eutire new construction: Front .............. : Rear . .............. Depth ............ Height ............... Number of Stories ...................................................... 10. DateofPurchase . . l I 1 Zone or use district in wlfich premises are situated .............. ' ........... ' 12 Does proposed construction vie ate any zoning law ordinance ox' regulation: 13. Will 10t be regraded ....... ; ................... Will excess till be removed from premises: Yes Nb 14. Name of Owner of premises .......... ;... ~.... Address .. i ................ Phone No ................ Nmne of Architi~ct .......................... Address ................... Phone No ............ : .... Name of Contractor ......................... Address ............ : ...... Phone No ................ 15.' 1.s this property within ~00 feet of a tidal wetland? *Yes ........ No. *If yes, Soutbold ['own Trustees Permit amy. be reqnired. PLOT DIAGRAM Locate clearly and distinctly all buildh~gs, wbetlmr existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and ~bow street uames and indicate whetlmr interior or comer lot. STATE OF NEW ~50P, K,x,-, ~ . · ...... ~ , , ~,~ . . ' .................. being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) above named. i (c ' ) . o ent, corporate officer, etc. of said owner or owners, and is du~y anthorized to Imfform or have performed the said work and to m~e and file this applicafion; that all statements contemned in this application are frue to the best of bis knowledge and belief; and that the work will be performed in th~r set forth in the application filed therewith. Sworn to before me this / ~ ~ __.~L;~"Po~ ,.o~ ..... . ~. ' (Signature ofapp cant) NO. 472fi089, Suffolk Cou~V, " ' Ter~ Expires May 31,