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Home My WebLink About20961-z lwO~M NO. ~ TOWN OF $OUTHOLO BUILD)NG D£PARTMENT TOWN HALL SOUTHOLD, No ¥o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N°-N? 20961Z Permission is hereby granted to: / , /~ / ~ . _~ ~, ,o ........ at premises ,~ated at ...~.~....~..~.....~.~..~.~....~ ...... ~~ ........ co..~ ~ ~op N~. ~0oo s~t~o. ...... LAg. ......... B~ ....... ~.~ ....... lot No. ~..I ................. pursuant to application dated ............ L..~. .......... , 19.~...z~'..., Building Inspector. Fee $ ........................ and approved by the Rev. 6/30/80 FORM NO· 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-t 802 ixamined ~..~ .I .'l, 19~ \pproved .c~..~,~o~,. }.q;, 19~ ~. Pe=it No.~ 3.~.I. .~ )isapproved a/c .... . ................................ . APPLICATION FOR BUILDING PERMIT BoAgD Oie HEALTII 3 SETS OF PLANS SURVEY ................... CIIECK .................... SEPTIC FOR,q .............. ,,0, I PY: c^,.~..9.65...'5./.72, ........ HAIL TO: Date ......... : ......... 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter 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 ' areas, and giving a detailed desaription of layout of property must be drawn on the diagram which is part of this appli- tion. e. The work eoverdd by this application may no~t 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 all 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 all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department ~or the issuance of a Building Permit pursuant to the filding 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 alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with ail applicable laws, ordinances, building/~lo.~), bowaing eod~e, and regulations, and to mit auth°r/zed inspect°rs °n premise: and in building f°r necessary insp~?.r .~' -- ; ' (Sign~t~r'e';f applicant,'COfname, if a corporation) (Mailing address of applicant) ate whether applicant is owner, less~rchitect, engineer, general contractor, electrician, plumber or builder. · line of owner ofpremises 2-//9/'-e ,~ ~. .~.o, ~'. r,,/ (as on the tax roll or latest deed) applicant is a corporation, signature of duly auth~ori~d officer. DATE: ~~.P~ # (Name and title of corporate officer). Ngr~F¥ BUILDING DEPA~.TM~N~f AT 765-1802 9 Atvl TO 4 F'M FOR /HE Builder's License No ..................... C) .~..,~.~-..~. .. FOLLOWING 1. FOUNDATION '[V40 REQUIRED Plumber's License No FOR POURED CONCRETE 2. ROUGH ~ FRAMING ~ PLUMBING Electrician's License Nb 3. iNSULATiON 4, FINAl. CONSTRUCT{ON MUST · ME COMPLETE FOR C,O. OiherTrade's License No ..................... ALL CONSTRUCTION SHALL MEET · THE REQUIREMENTS OF THE N.Y. Location of land on which proposed work will be'done ...................... ~T.~T.E..CO~g,T.~U.CTI. O.N' &. ENERGY .... ~'. o ./ ':r~c o ~.~.1~. O~ qpNSTRUCllON ERRORS llouse Number Street Hamlet ' ' County Tax Map No. 1000 Section ..... /./. ~ ......... Block .... 4...; ......... Lot Subdivision , ,ff,,/~, Y.,,~?. /°o/,o? CLq.~ Filed Map No. .'7.~5/.~. Lot (Name) · State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ./?../f:/.,~..~./..a(.~....~..~./~. ~..~...~.~o. gq(..~...777% .... ,,.e,2~., ,~,~,~ .~/'./. ~,,.a~.',.~.~.~;~/~..O. 1.~ '~: ~ Intended and · use occupancy .... . ... ~ .. property lines. Give street and block interior or comer lot. 3. Nature of work (cheek which alpplicab e) New Building .......... Addition .......... Alteratio~ Repair . .~:~; ......... Removal.. ~tk~ '~- Demolition Other Work 4. Estimated Cost ~' .~.. i &.~:.~ (Description) ..................... Fee ........ .'~ · i (to be paid on filing this application') $. Ifdwelling, numberofdwellin~units ............. Numberofdwc~llingun soneac eof. If garage, numberofcars . . i ....... ',.__"-~. ' it h fl ............... 6. If business, commercial or mixdd .......... Dimensions of existing structurt ,~,-;u,uancy, specny nature and extent of each type of use ..................... 7. s, ifany: Front ........... ~. ·. Rear ........ ...... Depth .............. Height ............... Number of Stories ........................... Dimensions of same structure With alterations or additions: Front .................... Depth Height ................. ~ . Rear .................. 8 ................... t ........................ Number of Stories .......... · Dimensions of entire new construction: Front Rear ....... .............................. Depth ............... 9. ~ze otlot: Front .... i ,, ' ............................................ n .... t~,. ~. '' /,fi,W; ......... ixear .................. Devth II. ~oneoruseaistnct~nwhtchprCmisesaresituated ~-.~. ~/~'cr~,~' ~'A~J ~'kb)~'~--'_2)~': ....... 12. Doesproposedconstructlonvm!ateanyzomnglaw, ordinance or regulation: ...~.~ ",gill lot be regraded ..... ' ...... · 13. ' ~ i .-- ............. Will excess fill be removed from premises: Yes No '~ .......... l ................. Address ................... Phone No ...... ~. ' i ...... Name of Contractor ......... ~ ............. . ....Address ........... Ph~na 15. Is this property within 300 feet of a tidal wetland? *~e's.. ?..'.'.'.'~"' ......................... · 'rf yes, Southold Town Trustees Permit may be required. PLOT DIAG Po~ Locate clearly and distinctly all Ibniidings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether ' ' . ........ ~,.~d~~ ~.~.. . being duly Sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. ~ . fe is tbe ! f said owner or owners, ~d is duly ali~thorized to perform or have performed the said work hnd to m~e and file this ~plicafion. that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ork w~l be perfo~ed in t t ~e manner seit forth in the application filed therewith. ~om to before me t~ [ ,x, . ' ............ . .... ~11~ In 8Eff~k Cpu~__~ / ' / (~ignaure of applicant)