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Home My WebLink About20539-z lvOE~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~AIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N? g053gZ Permission is hereby granted.to: ...... at premises located at .......~...../~...?.~...~...~.~..,~. .......................................................... County Tax Map No. 1000 Section ........... ..~...,"~. .... Block ~ Lot No. '~/ ~' ,,///O . 19..~.....~.., and approved by the pursuant to application doted ......... /.~/..; .................................... , Building Inspector. Fee $...~.'...,~.~ Rev. 6/30/80 used ,utin~ hal~ be )R WFUL ;fflFICATE GY N .I 1°25' ~O"W, @, 20,210 S.F. o trout p~ = ~ MO~UF'IF_HT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 .,, TEL.: 765-1802 EXamined ........ 1~...2.. 'Xpproved .... . .~..// ....... l 9q.Y:Pe nnit No. ~,t~.~.4~..~. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ltO,'k~D OF HEALTII -3 SETS OF PLA2{S .......... ~URvEY ............. ....... CIIEcK .......... SEPTIC FOR:I ........ .... Date 0 ................. , 19 . a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ;ts 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 streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- etlon. c. The work covered by tkis application ma'/' not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Bt]ilding Inspector will issued a Building Permit to the applicant. Such permit ~all be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupancy tall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buildin,, P ' udd~ng Zone Ordinance of the ~own of Southold, Suffolk County, New York, and other applicabl for the constractiori of buildings, additions or alterations, or for removal or demolition, as herein described. segulations, he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in buildin~ for necessary inspectionls. __, ..... ..... ................. (Si°nature 'bt' applidant, or name, if a corporation) (Mailing address of applicant) ate whether applicant is owner,'lessee, agent, architect, engineer,~_~.~al co~lectrician, plumber or builder2 f o~v line o ncr ofpremis .... (as on the tax roll or latest deed) applicant is a corporation, signatur~ of duly authorized officer. ..... (/¢am/ind iiti/or co/porate o~ce;) ......... Builder's License No .......................... Plumber's License No ......................... Electrician's License No Ol,~or r~ade's License No...o..a..S?. ............. Location of land on which proposed work will be d~ne. · 3 / '7~ s~S Knh~? ' llouse Number ........... Street ................. Hamlet ................ County Tax Map No. 1000 Section ... ..... 7. ........ mo~k ......~ .......... ~ot...~[. ............ Subdivision .....................................Filed Map No ............... Lot ............... (Name) ~.Intendeduseandoccu a ~ ~ ' ' ~ ' ; '' ... ..... .3. Nature of work (check which applicable): New Budd n~ ......... Addit on ...... ,Mterarion ..... .~/.~. Repair .............. Remloval .............. Demolition .......... Other 9, ork /-~/~_,.. . ~ ~r3OIDi ~ .' ~ (Description) 4. Estimated Cost ....... ; .. Fee f dwelling, number o : (to he -aid on filing this application) 5. I fdwellingiunits ............ Number o£d h floor ............. · If garage, number of cars .... . · · · welling nnits on cac 6. Ifbusiness, commercial r m~xed occupancy, specify nature and extent of each type of use . . . 7. Dimension~ot'existing structurds, if any. Fro it . Rear .. ' ................ Heght . ,~..~ ... -, ' ............ · · · · t'mmoer of Stories ' ' ' i ........ Depth ........ Dimensonsofsamestmc~ .... ~. . ' ..... ~ ................. ' ...... ~,~,,- wire alterations or additions: Front ......... Depth : Rear Heil.,ht .................................... 8 .................... i ..................... Number of Stories · Dimensions of entire new construction: ' ' ' Front ...................... Height Num Rear Depth 'her of Stories ............... ' .............. 9. Size of lot: Front ! ........................................................ I0 Date of Purchase ...................... Rear .................... Depth .................. ........... . ........ '. N fF · h p ~ ........ amc o Onner Owner 1 I. Zone or usc district ,n whic re nises are situated ......... ' ............................ ?.? 14t ............................... 12. s proposed construction vio e any zonin~ law ............. 13. wm lot be re~,radea ~ ~ ---, ordinance or regulation: .... .~.0. .......... N f O ° f"p ..... ~ Wi excess fill be removed from premis%s: Yes 14. amc o wrier o remises ... ~ ........... Address ......... Phone No ................ Name of Architect .......... i .......... Name of Contractor..,~-~C..,~t.X,4._~. '....' .... Address ............. Phone No .......... .5. IS thi~p~roperty within' 300'Ofee~ of' a ..... Address .~..0: .~ ' .'~.~. '~.~.N.~.. P~one Nh' _']/(~C~--LP..3"2.[~ tidal wetland? *Yes ...... ~ ..... ~'~ .....,..,~r.. · 'x~ yes, Southold TOwn Trustees Permit may be requir~ .... ~-'~ ........ .,..' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing · roperty Lines. Give street and block umber or description according to deed, and show street names and indicate whether nl . or proposed, and. indicate all set-back dimensions from nterior or coruer lot. NO'riFt BUIL~ING DEPART~T~ ~-I802 9 AM TO g PM FOR THE FOLLOWING ~NSPEC'/IONS: ; % FOUNDATION - '~0 REQUIRED FOR POURED CONCRETE 2, ROUGH ~ FRAMING & PLUM;DING 3. INSULATION 4, FiglAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ~EET 7HE REQUIREMENTS OF THE~ N.Y. STATE CONSTRU~ION & ENERGY CODES. NOT RESPONSIBLE i FOR DESIGN OR CONSTRUCTION ERRORS / / c DJ.` \ \ \ \ ATE OF NEW Y,,OR-K. _L"~C> //. S S J (Name of individua} signing c~ntract) .... being duly s~vorn, deposes dad says that ho is thc applicant we named. . , '- ' i~ (Contractor,)a~cnt, corporate oliicc .............. licatinn; that all ~ .,~nzca [o permrm or have performed thc said work and to make ~d statements contained ~' ,m this application are true to the best of bis knowledge and belief; and that the k will be perfumed in the manner set ~orth in the application filed therewith. ,m to before me this