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Home My WebLink About21244-z IFOTM NO. ~ TOWN OF SOUTHOLD BIJJLDJNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21244 Z Date ....~. .................................. . ~..~._a Permission is hereby granted/~o:/ //~/ ~...ff~....e~ ........................................... ........ ~...~~../~ ............. _ ...... I'o County Tax Mop No. 1000 Section ........ /~...~. ...... Block ~' Lot No. ~ pursuant to application dated .......... ...~.'..~.....~... ........................... , I~..., and approved by the Building Inspector. Fee $..~..~..5,~ Rev. 6/30/80 ,t.,,,~,,TOV~/N L;. t;,~_ ,;';~,:} SOUI'HOLD, N.Y. 11971 TEL.: 765-1802 Examined ........ , Approved ............... , 19 .~. Permit No. ffi.../.~. .~..~..~. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL g~K~D OF Hr-^LrH ......... 3 S~TS OF PL;,~$ .......... SURVEY ClIECK .................... SEPTIC FORH .............. HAIL Disapproved a/c ................ ' / . ~¢~Buildin= Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets of plans, accurate plot 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- bation. 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whol~ or in part for any purpose whatever until a Certifieat~ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department tbr the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Nameofownerofpremises./~j.~,.d.~.~..~-.~'. ............................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... £?~/~ .......... Plumber s L~cense No ......................... Electrician's License No. Other Trade's License No... .................... 1. Location~°f land on which, proposed work~ will be~,~ ~-~d°ne .................. )/)~ .~ ' ' .'/7' ' ': ................ . House Number Street Hamlet cotmty Tax Map No. 1000 Section .../.~. ~ ......... Block ..... ~'.)..~--~... i... Lot ..... ~...~.~. ....... Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) Stat~ existing use and occupancy of premises~and inte.~nded use and occupancy of proposed construction: a. Existing use and occupancy ./.... :. C?r{'~. -.~. ~ ..... .~.~. , .................... b I d d d -~,~,,~.~.~' ' · nten e use an occupancy .... ~ ............................... property lines. Give street and block .3. Nature of work (check which a~plicable). New Buildin- . ' ~ ....... ' ..... ' ' Repair .... d~.~ ....... Removal .............. Demolition-..,~,:~x~. ,,f .O.th~tWork~ij~:j ........ : ' (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ' Number of dwelling units on each floor ....... · ......... . If garage, number of cars ..... i ................................................................... 6. If business commercial or inixed occupancy, specify nature and extent of.each type of use ..................... 7. Dimensions et existing structurels, ~f any: Front ~..~o'7. 5.. Rear · ... ........ .J.~. ....... Depth .... .~'. ........ Height Num'ber of Stories Dimensions of shine structure with. hl~[erations= · or additions; Front · ........ · ....... Rear . ............. .. . . Depth ' Height ' Number of Stories 8 Di f ' t~qt' R ·H mensionSight o entire, new~;>.! ~c°ns: N ~ig '~:' lonf stFr°ntri ............... e~r ............... Depth ............... e .......... ~: ..i u ore o es ............................ 9 Size of lot: Front ! Rear .......... ~., ................................ Depth 10 Date of Purchase ' ' Name of Former Owner 11 Zone district in which prdmises are situated · or use ............................................. 12. Does proposed construction violgte any zoning law ordinm{ce or regulation: 13. Will 16t be regraded ....... "' i ................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' Address Phone No Name of Architect .......... I ................. Address ................... Phone NO ................. Name of Contractor ........ I .... Address ............... Phone No ................ 15. Is. this property w~thin 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, S6uthold ~own Trustees Permit may be required. PLOT DIAGRAM · Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from~ mmber or description according to deed, and show street names and indicate whether interior or corner lot. . : ' . ~ ~ = ~ ~ ~ ~ ~ STATE OF NEW YORK, c, o ~ ~ 2 ~ m~"~'~-~ [ ~ ~ ~ ~ O- cou oF ....... .. . ~.o -~ -~6~ 8~°z~ above named~~e' uivlaua~gnmg comraco . ~ ~ ~ ~ O ~, ~ ~ g ~ ~ . He is the . .. ............................. . (C~ntractor, agent, corporate officer, etc ) of said owner or owners, ~d is duly[authorized to perfOm or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner ~et forth ~ the application filed therewith. sworn to before ~is ~ ,, . ....... ..... Nota~Publio,~tateo~NewvorkNo. 495136~ '- ~-// '''' . e [~g~ture of applicant) ............. Qualified in Su'~olk CounW ~ ' . Commission ~pires May~, 19 ~ ~ .. ,'~ .