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Home My WebLink About20383-zTOWN DF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 20383 Z Permission is hereby grgnted to: ~ . ~~..-~,Z'.~~. ................. , ~..~.,... ~.,......~....,~.....L~.z~ ............................. ............................................... ............................................................................... County Tax Map No. 1000 Section ....... ~ ...... Block .......,,~.,. ........... Lot No ....... pursuant to application dated .............. ./..//.~... ............................ , 19..~....~; and approved by the Building Inspector. Rev. 6/30/80 ~ {~ ~':, ............................... ~' , TOWN OF SOUTHOLD t2/., 'I},(~ J~l/l'l ~C~9 hI BUILDING DEPARTMENT " ~il;:~' . - ,!!, TOWN HALL {, ,, p~? SOUTHOLD, N.Y. 11971 ;!..?. ~. ~ i, TEL: 765-1802 Exam ...... 19 Disapproved a/c ..................................... N¢'h'Y ?~E~5~ O~ildi~/nspector) 765-1802 9 AM ID 4 PM FOR THE V()LL. OWtNG !NS~ECTIONS; APPLICATION FOR BUILDING PERMIT 3.FOUNDATION '~,~O REQUIRED FOB POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING INSTRUCTIONS 3. ~NSUt. ATIO~ BOAKD OF HEA~TH B S~TS OF PLA~$ .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL .~r~ ........ HAIL TO: Date.../../?. ......... , 4,.,,FINA[ ..,- .CONSTR.IACTION MUST a. z~ ~'~tL-~g¢~b~ completely filled in by ~pewfiter or in ink and submitted to the Bulldog Inspector, with 3 etqof, ng~ ~, ~ l~[c E~e accordzng., to schedule.. b.~~~l~t c o~nd of buildmgs~ on premises, relationship to adjoining premises or pubic streets or are~~~ ~s~of layout or property must be drawn on the diagram which is pa~ of this appU- cati°n'coD~s. NO%,~ES~ONSI~E~ FOR . c. ~(~~R~n may not be commenced before issu~ce of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pe~it to the appQcant. Such pe~it sh~l be kept on the premises,pvaflable for inspection throughout the work. e. No bui[digg ~hg[l,:b~,:6~Cupi~g~-~ed in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall hav~ b~¢ ~yante~ ~' ~be-~g~i~g :~n~p~ctor ArrtleA~ION..~:.~g'~g6,~;~bO~,$~,~he Bulldog Dep~ment for the issuance of a B~lding Pem~t pursuant to the Building Zo~e~O~¢iH~'& 0[ [~:~'W~H'6~6uthold, Suffolk County, New York, ~d other app~cable ~ws, Ord~ces or Regulations[ ~?~r~b~{~bf bu~dms, additions or alterations, or for removal or demolition, as here~ described The app~ca~{J~es,]¢~]~s~thJ~"}~t~cable laws, ordinances, building code, housing code, and regulations, and to admit au~ho~d~tom .~ ~rmises~d,~ bulldog for necessa~ inspections ' BE' COMPLETE FOR C.O ........... ~...~9.. ~; .... .~..~..~ .... ~... A[,L CONSTRUCTION SHALL MEET (Signature of applicant, or name, if a corporation) T~ ~EQUIRE~ENTS OF 'THE N.'. ~ STATE CONST~UCTION & ENERGY .. ~ ~ CODES. NOT RESPONSIBLE FOR (Mailing address of applicant) DfiSIGN OR CONSTRUCTION 5R~O~S State whethe~ applicant is ow~eL lessee, a~ent, a~chRect, e~i~eer, ~e~era] co,tractor, electrician, plumbe~ o~ builden ...... ................................................. - ........................ ..... ......................... (as on the t~ roll or latest deed) If applica~6rporati~ sign~uly authorized officer. ..... ( (Name and title of co,orate officer) Builder's License No .......................... Plumber's License No ......................... Electrician s L~cense No ....................... Other Tiade's License No ...................... / Location of land on which proposed work will be done.. ~.'~..2%..c.~.~.-~...//~..US .~.~.% fl.....~..2. ~. ~ ........ House Number (Street ' ' Hamlet County Tax Map No. 1000 Section . .... ~ ......... Block ..... ~ ........... Lot...7.~:f ......... Subdivision Filed Map No. Lot '~ (Name) "~ State existing use and occupancy of premises and intended use and occupancy Qfproposed construction: ' a. Existing use and occupancy ........ ~ .... '~. ~. 5 ~... ( ....... ~,~',~x~ e~;,i~e~,~'~ ....... b. Intended use and occupancy ~'~ ~ ~ / o :~;~,,.,,~ ~,~,. ......... ~ i~i~.~ ~,. ~-~, · ',,[~ ............ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...~. ...... Repair .............. Removal .............. Demolition . .... .,? ....... Other Work..~..r.~...~<.J. .... 4. Estimated Cost /t~ 0. b ~..'~ . ~' ..-CC. . (D~'sc~prfi°n) . .............................. Fee ....... (to be paid on filing this application) 5, If dwelling, number of dwelling units ............. Number of dwelling units on each floor ....... ......... If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ............ '. ........................................... 9. Size of lot: Front ......... ........ ' Rear . . Devth ~ I0. Date of Purchase .... ~ N~,/.... l.~.15:7.'/~i'. i ..... '~a~j 'o'f~(m'ir'~i~,','~," ~[-IrlC:"~'"~d*5'~5'e'f/ ....... 11. Zone or use district in which l~remisesaresituated.. ' . . ~. ..... ~"'. ....... i ........... f. ii'"ii" 12. Does proposed construction violate any zoning law, ordinance or regulation: ..p~..~) .......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ....... ~ ........ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No..~ .... ~ *If yes, Southold Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether interior or coruer lot. STATE OF NEW YORK~ ..... ~ ............ ~. .... :~.+. ~. (Name of individual signin~ contract) above named. Ite is the (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this ~pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ,york will be perfomed in the m~ner set forth in the application filed therewith. ~Wom to before me th~s .... /. · · ~%,¢ , .d~of. q°ta' PuA?c''5~~~~/C°unty-- ' ~pu~~ · 'P" · · '~ ....................... ~lm~ ~ 8~ ~N~ ~-761 ~g~O~ -- of applicant) ..... being duly sworn, deposes and says that he is the applicant