The URL can be used to link to this page

Home My WebLink About20928-z ~Ou~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne-N?. 209~8Z Permission is hereby granted to: /~ . ........ ...//...~~.,~ ~./..~~ .... ~.~ ~ ~~ ...... ~.~...~.~ ~ ...... ..... .......... ............ ~o...~.~ ..... ~ ....... ~..~ ..... ~:~.~ ..... ~~ ......... ~ ..... ~(~ ..... ~ ............... County Tax Map No, 1000 Section ........ ./'../..~. ......... Block ........ ..~.~. ....... Lot No .....,.~..~.. ............. pursuant to application doted .................................................. , 19.2.'.~,, and approved by the Building inspector. ~v. 6/30/80 . F(~RM NO, 1 AU6 3 i t3§2rowN!,OF SOUTHOLD : BUI~LDi~ ..... DEPARTMENT ' . '.iti:,'~: :'~'{:)~N HALL ! ....... ~., '.'/.~ ':~ ~ '.~'~ S'~HO;LD, N.Y 11971 :~x;mined .......... , I9 'pprovcd .... 7~/ ...... 19~Pe~it No. ~Z~.. )is~pproved a/c ............ --. ~Z~ilding Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTtl . ~ ....... 3 SETS OF PLA~IS .......... SURVEY ................... SEPTIC F 0 R,"I .............. HAIL TO: Date ' 19 INSTRUCTIONS a. Tlds appLicati~n must be c~mp~ete~y fi~Ied In by typewdter ~r in ink and submItted t~ the Build~ng Insp~ct~r~ with 3 :ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show/ng location of lot and of buildings on premises, relationship to adjoining premises or public streets : ar, eas, and giv/ng a detailed description of layout of property must be drawn on the diagram which is part of this appH- '.tion. ~: The work covered by this apptidaUon may no~ be commenced before issuance of Building PermiL d. Upon approval of this application, the Building Inspector will issued aBuUdingPermit to theappHcant. Suchpermit :all be'kept on the premises ava~able for inspection throughout the w6rk. e. No building shall be occupied or. used in whole or in pazt for any purpose whatever until a Certificate of Occupancy .all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alteratinns, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to imit authorized inspectors on premises and in building for necessary (Signature of applicaqt~ or name, if a corporation) .. (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~me or owner ofpremises.](~ ~I .~../'D. . ./OC.. . .~.. /')Q.....~'~)O ~__~. . . /< . .f~.. U / D~//~/) .. ' .. (as on the tax roll or latest deed) APPJlOVED AS 80T£D applicant isa corporation, signature of duly authorized officer. DATE ......... '; ...... '-- ' 'tit' .... : ........ · (Name and le' of NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE Builder's License No ' FOLLOWING INSPECTIONS; I, FOUNDATION TWO REQUIRED Plumber's License No FOR POURED CONCRETE · . 2. ROUGH - FR;~MING & PLUMBING 3, INSULATION Electrician's License N~ .................. °'°'' 4. FINAL CONS'~RUCTION MUST Olhcr Trade's License No ~3E COMPLETE FOR C.O. _ ,~ALL CONSTRUCTION SHALL MEET Location of land on which proposed work will be' done .... ~ .... t.:. iv'.... ~..,~. )fTC..'.~I}J,5.T~..U.C.TI.O?.: .~: .~.~:~G¥ ................................................... .~J ~)e~!G~ OR CON UCT ON ERRORS l louse Number Street ............ .R.C..O.N.Sy~ ............ Hamlet County Tax Map No. 1000 Section .................. t~ocn ................ Lot ................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: E isting use and occupancy ........ :.. -- b. Intended use'and occupancy ....... V 3. Nature ofwor~ · i. O, (check which aPphcable): New Building .......... Additi n .......... Alteration ......... Repair ............. Remoyal .............. Demolition .,. ...... Other Work ~gT~....~ .... ~ ' ' (D ription) 4. Estimated Cost . ~ .OCZ>... ese (to be paid on filing this application) 5. If dwelling, number df dwelling u'nits ........ _ ...... : 7: Number of dwcSlling units on each floor ............... 7. , ..... , no': ~rent ............... Rear ......... :.... Depth .... '. i ..... nezgn[ ............... Number of,~6ries .......................... . , , , .... '. , '. ' .... Dzmenslons of same structure with a terations or additions. Front ' : ?' '~'~' ........ Depth ...................... Height ................. Number of S,iories ............ ~,...,. ..... 8. Dimensions of entire new const~ction: Front'.. ~o?i ........ Rear ........ '. } .....Depth .{.q~.. :'. ..... Hei'ht Nun 5er of Stories ' 9 Sizeoflot: Front ,~..aa el°) i~?i ' .... I0 Date of Purchase ' ' ~ ......................... ' ' Name of Former Owner 1 I' Zone or use distric[ .......... ................. · ........................... · in xvhich premises are situated : .'rm. · 12. Does proposed construqtion viola:re 14. NameofOwnero remises ~,, Name of Architect .......... Address · · . Phone N Name of Contractor ..... >.. , ' Address ........ Phone N6 ........ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ..... ~.. tlf yes, Southold Tbwn Trustees Permit may be required. ' '", i' PLOT DIAGRAM ,.. Locate dearly and distinctly aIl'buiIdings, whether existing or proposed, and, indicate aIl ~et-back dknensions from property lines. Give street and block number or description according to deed, and show stregthames and indicate whether interior or comer lot. STATE OF NEW YORK, {Name of individual signing contract) · · , being duly Sworn, deposes and says that he is the applicant ~bove named· {e is the .......... . ................................................ · (Confractor agent corporate officer, etc ) ............ ,f said owner or owners, and is dulylauthorized to perform or have performed the said work had to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the' h ' · 'ork will bc performed in t e manner ,set forth in the application filed therewith. ;worn to before me this Nota~'Y p~.b. llO, State of Ne~ I'io. 4876506 QualifledlnSufl°lkC°UnW 'O~''1 ' ' .................. Con~mfl~slen E~q~ltes Dee, ember 8,19-~.-~'"~ (Signature of app]lcant)