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Home My WebLink About21213-z FOB, H NO. :B TOWN OF SOU'DIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) at prem,ses located at ....,~...~.~'...........~..,~.,~.... ............................................................................. ................................................... ............................................................. County Tax Map No. I000 Section ...... Z.Z.Z ...... Bilk ......... ~. .......Lot No ....... ~.~¢.~. pumuant to application dat~ ....... ~ .................................... , 19.~ and approv~ by the Building Inspector. Rev. 6/30/80 FEB - 3 Igo l FORM NO. 1 TOWN OF SOUTHOLD 13UILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 . Disapproved a/c BOARD OF HFALTII ......... .3 SETS OF ?L.~.~S ......... SURVEY ................... CIIECK . .... c^LL23.t....q.,g...5 ....... HAlLTO: APPLICATION FO[-I t, UI LDING PERM IT : ~... ~.~.~,., Date .... .... 19... INSTRI/CTION~ a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatioJ"ship to adjoining premises or public streets or areas, and giving a detailed description df layout of property must be drawn on the diagram which is part of this appli- cation. ' ¢. The work covered by tbJs application may not be con',menced before issuance Of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to [he applicant. Such permit ~h?II be kept on the premises available for inspection throughout the w6rk. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~hall 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 3uilding 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. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspections. ,.9. c . . . 2 , . --%,, -,, :,r>,, - - .. ~ (Signature of applicant, qr name, if a corporation) ........... ,' . ' Mailin addre ' ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ' ............................... ame of owner ofpremises , ,- ' (as on the tax roll or latest deed) £ applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ..... Plumber's License No ......................... Electrician's License No ................ Other Trade's License No ltouse Number Hamlet ' County Tax Map No. 1000 Section .......... ,~ .... Block ....~. · · · ~ ....... ' Lot.. . ~. . .. Subdivision Flied Mhp No ' (Name) State existing use and occupancy of premises and intended use and occupancy of proposed cohstruction: a. Existi d occupancy ...; ........................................ b. Intended use and occt~pancy ....................... 3. Nature of work (check whichiapplicable): New Budding .......... Addition .... Alteration .... Repair ......... Removal .............. Demolition .............. Other Work . ~ ...... ' ' 4. Estimated Cost ..... ' ese on) .... : ......................... Fee ...................................... . i ~ (to be paid on filing this application) 5. If dwelhng, number of dwellinlg units .............. Number of dwelling units on each floor. If garage, number of cars ... i ...... ~ ................. ..... i o. ccupancy, specify nature an ............. ................. 6. If business, commercial or mixed d extent o ~ ..... 7. D~mensmns ot exmtmg structu ~ f. each type of use ..................... Height ... res, ff any: Front ....... Rear Depth .... ............ Number of Stories ........ ' .... · .......... i terations or additionsl ........................... ' ..... Dimensions of same structure vith al Front ............. Depth ................... i'" Height ................ ,. ~.~ (v.o?,.. · · .. Number of Stories ............. ~.'L . 8. Dimensions of entire new cons{:ruction: Front 'w:%.L Rear ............... Depth ........ Height . .~.fl./yu¢ · berofStoNes ...... , ........ -. . 9. Size oflot:'F ................... · ............ Rear ................... I0. Date of Purchase .................... ~ Depth .................... 1 I. ' ......... .......... ' ......... Name of Former Owner .......................... Zone or use district in which premises are situated ......... ... 12. Does proposed construction vidlate a ...... ' ' :' ' ............ Y' ............................ ,v -y zoning law, oramance or rcoula/lon ......... 13. Wi l lot be regraded . X~! o ' : Name of Owner of premises ~. ~. ~ ........ WIlII e×c~s fi!~ be rvqmovegi from premises Yes 15. Is this property within ~00 feet of -' 255' . ...res? .~,&. ~. a~., ~..~ne No. yes, ~outno~a '~'own Trustees Permit may. be requir~'~''~ ....... . · .... PLOT DIAG~ Locate clearly ~d distinctly MI[ b ' ' ' ..... ' ' ufldmgs, whether existing or proposed, ~d. indicate ~I set-back d' ' ~ensmns from prope~y Hnes. Give street ~d block humber or description accord~g to deed, and show street nines and indicate whether ~tefior or coruer lot. .. t ,PPRO D AS N ED ........ 76~-1802 9 AM ~ 4 PM~R THE FOgLOWING INSPECTIONS: ~[: . - ., I~ O. /~' FOR POURED CONCRETE ;'~ [ 2. ROUGH . FRAMING ~ PLUMB " . [ 3. INSULATION ~' .4. FINAL .. CONSTRUCTION / BE COMPLETE FOR C,O. ;TATE OF H[W ~... ' ~ ~ ALL CONSTRUCTION SH~LL MEET :OU~OF .... ~-~... S,S THE REQUIREMENTS OF THE ....................... CO ES., N~ .RESPONSIBLE FOR (Name ofindividual signingicontract) .' C~d' ~ D ENERGY bore named. ' ,. ' (Contract~orporate officer , etc.) said owner or owners, ~d is duly authorized to perfo~ or have perfomed the said work and to m~e and file this ~plication; that ail statements containe~ ~ this application are true to the best of his knowledge and belief; and that the ork will be performed in the~ner set; forth in the application filed therewith · vO~tobeforemethis// . [' -- ~0. 4Z25089, 8uffo~ ~u~,, x. ' ~/~Z _ (Signature of applicant)