The URL can be used to link to this page

Home My WebLink About21468-zFO~M NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-° 21468 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....... ~'...~,.. ................ : .......................... 1 9..~,~.,. ./ at premises located at ..................................... Counh/Tax Map No. 1000 Seotlon .......... ./.../..~.. ...... Block ............... ~ ..... Lot No ....... ./....7,. .............. pursuant to application dated....~ ........................................ 19....~....~.. ..... Building Inspector, '~' ~//'~' ~'/~"~ Fee $., and approved by the Rev. 6/30/80 Approved .. ~../oe. .......... 19 ~,~. Permit No. / FORM NO. 1' TOWN OF $OUTHOLD BUI LDI.NG DEPARTMENT TOWN HALL ' COUTHOLD, N.Y, 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ............ ' .......... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: D sapproved~jjLl,~J}.~.[[D. A.$.~.~ . ' " ' 765-1~2 9 AM ~ 4'PM FOR THE .... -'f~'F~~' f~'~ ..... FOLLOWING INSPE~IONS: ~uu~lnspector) 1. FOUNDATION - ~O REQUIRE~pPLICATION FOR BUILDING PERMIT FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONStRuCTIoN MUST INSTRUCTIONS BE COMPL~E FOR ~,~l~~~o~ely filled in by ~pewfiter or in ink ~nd submitted to the Building Inspec}or, with 3 sets ~Ja~[~[Mg~ ~ Tg~a~ZFee according to schedule. c. The~o~ covered ~;~v~;ic~t[oii may not be commenced before issuance of Budding Permit. shall be~[~B~is~~r~spection throu~out the work. e. ~~n~e~2~;~ed in whole or in part for any purpose whatev~ unti~ a Ce~mcate of Occupmcy ~. PUU~ATION 2 ~O REQUIRED APPL~~~ADE to t~e Build~g Dep~ment for the issuance of a B~lding Pemit pursuant to the Buildin~.~di~t~ ~outhold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Rcgula~o~B~l~onstmction of bufld~gs, additions or alterations, or for ~emoval or demolition, as here~ described. The a~li~g~es~g~~plicab~e laws, ordinances, b~fld~g, code, housin; code, and regulations, and to admit aut~~remises and ~ build~g for necessF~ inspections. THE REQHIRE~OF~T~_~_[~ ....... . STATE CONS~~ ~ ~ERG~ ~ (S~gna;ure ~phcant, or name,~ a corporanon) ~ESIGN OR CO~ ~ (Mailing address of applic~t) ' State whether applicant is owner, lessee, agent, ~chitect, engineer, general ~ontractor, electrician, plumber or builder. ..... ....... ................................................ Name of owner of premises If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... J .O. &.o..~,, J:~.W~ ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1 L cationofl nd lichp opo d k illb do ' ' · o a onwl r se wor w e ne ............ .'. ~ ~.~. tlouse Number Street Hamlet County Tax Map No. lOOOSection .... /.l..~ ...... ', ' Block ..... ~ ........... Lot ..... l..~.. ......... Subdivision ..................................... F, iled Map No ............... Lot ............... (Name) 2, State existing .se and occupancy of premises and intended use and occupancy of proposed constrnction: ~'¢c3 / a. Existing use and occupancy · . · ........... (check wh ch appl'icable), New Bu id n" ' 3. Nature of work , , · s .......... ttumuon .......... Alteration Repair .............. Removal .............. Demo it on .............. Other Work, e..a.4.. ~ (Description) 4. Estimat6d Cost ... o C~ ,~ c_~ c~ ~ ~. ........... [ ............... ; ........ Fee ..... ~.c2 ~ ...... ' (t b id filing thi appli rio ) 5 Ifd Iii i o epa on s ca n b f d Ill unit Nt mb f d Iii its ' · we rig, hum er o we ng s ............... i er o we ng un on each floor ............. If gurus-e, number of cars ,. 6 Ifb si .................................................... I i d 0 y sp cify n d nt of h f ................. · u ness. commercia or m xe ccupanc e ature an exte eac type o use ............ 7 Dim ions f xi ti lif FrOnt · ens o e s ngstmctures, any: ............... Rear ................ Depth .............. Height ............... Number of Stories ............. ·, .............. ¥., %; Dimensions of same structure w~tt} alterations or additions: Front ..... ' , ~ ' '; ........... Depth ................... I. I-Ieight .............. "Number r~e qt,~,4,~--' "' ' ' '. ,' ....... 8 ........ , ,,,, ............. · ..,...; ..... Dimensions of entire new constm on: Front ............. Rear ............... De . ........ · ' pth ' Height ............... Num r of Stories .............. ;. , .... . 9. Size of lot: Front ................ Rear ...... ~.., ,' Depth. ' ..... I0. Date of Purchase I ................. ? ........ ~.'~-... -.. I. · ......... Name of Forn~er Owner ............ ;-.. 1 1. ,~,,u .... ~ m~mc[ ~n wmcn prem~mes are situated ............. . . ' ' i ......... aw, ordinance or regular ~1 i ..... 12. Does proposed construction violate any zoning 1 ion: .... .c~ ....................... I3. Will lot be regraded .... ~ a x~ .... c r~ ......~ --~'-.' ' ' ~' '~ ....i' ...... : ...... wdl excess 011. be removed from prom scs Yes x,~__ ~ ..... · ~' `ff. '_'~ ........ Address ~Q/& 15,z,.~-qTr. Ueu,?,~?. Phone No. .~],m~ u[~xrcmmcl: ¢. ..... :'' '~-~ .............. Address .... .V-~.... .'-~.~. Phone No . iName oI Contractor :a'%w~,~ ~ .r. T~'e~ ~ q. ~ .... ,-~ 'L '2 ,-", ' ' ', ............... 15. Is this -ro-e .... · '..~_' '~'_ ~'~'~y..~.~,.~ ^aaress ~.X~,.~5..5-~ ~.q~-xl~.~.cl.. Phone No. '~te~', ~.O.q.O.i.. p p [Ly .LOCac~o wlthzn~O0 feet of a tidal wetla, nd? *YES .... NO..~. · If yes, Southold Town iTrustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frorr, property lines. Give street and block n~mber or description according to deed, and show street names and indicate whethe: interior or corner lot. STATE OF NEW YORK,, , ~ COUNTY OF ,~?. SiS C. r.,/ SI .... - . . ~. e-~-{{-.~ .... ,. · , . .I. . of individuals ningcontract above named· No. 4951364 Commlv~i~n ~plre~ May ontractor, age!~t, corporate officer, etc.) ' or said owner or owners, and is duly ia,u, thorized to pe,rform or have performed the said Work and to make and file this apptication; that all statements contained in d~is application are irue to the best of his knowledge and belief; and that the Work ~vill be perforlned * m the manner ~et forth in the application filed therewith. Sworn to before mc this [ (Signature of applicant) ....... being duly s~vorn, deposes and says that he is the applicant