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Home My WebLink About20964-z TOWN OF SOUTHOLD BU~ ILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N N.o 2096 Z County Tax Map No, 1000 Section ........ ../...~.....~.... Block ...... .~. .......... Lot No .......... ~.. ......... pursuant to application dated .... ~,. ...................................... , 19.~..~., and approved~ by the Building Inspector. Fee $,,, -~,,~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDI.NG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ×amined /. .......... , 197..2, Approved ..,~. ......... I .r~_~.. Permit No....~.. ?.~..~ Disapproved a/c ..................................... APPLICATION FOB BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ . a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or areas, and -iv' ,, o m= a detailed description of layout of property must be drawn on the diagram which is part of this appLi- cation. 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. c. No building shall be occupied or used in whole or in part for m3y purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspedtor. APPLICATION IS HEREBY MADE to the Btiilding Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town 'of SouthpLd~/Suffolk County, New-York, and other applicable Laws, Ordinances or Regulations, for the constmc~iofi-of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinancbs} building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ihspections. .. , ,(Signature ct appI~ant or name if.a co~oranon) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... gOTIFY ,'~ED~G DE (Name and title o£ coq~orate officer) 7~S~~802 9 AM TO ,~. PM FOR THE FOI&.OWfNG INSPECTIONS. Builder's License No .... ~. ~.~ l~. ~... *~.-~ ...... 1, FOUNDATtOI~ TW~ REOUIRED FOR POURED CONCRETE Plumber's ~iceuse No ......................... 2, ROUGH - FRA~ING & PLUMBING £~cctrician's License No ....................... 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR OfitcrTradc'$ License No .................. .... ALL CONSTRUCTION ~ MEET THE REGUIREMENTB., Ol~ ~ N.Y. I. Location of land on which proposed work will be done. ' STATE CO~ti~ !louse Num bet Street, ' Hamlet ' ' County Ta×, l p No. 000 Sectio ... ..... '.... mock .... ......... ..... O.6, ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Nanle) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check whichI applicable): New Building .......... Additien .......... Alteration ........ Repair .............. R!moval .............. Demolition ..... Other Work. ~. ~..~.q..._~... 4. Estimat cst ...... ~, ripti ) · 5 If d I j (to be paid on filing this application) llihg Nt ' · welling, number of dxve units ............... m~ber of dwelling units on each floor ..... If garage, number of cars } .................. · ..... 6. If business, commercial or raised occupancy, specify nature and extent of each t e of use Dimensions of existing struct res if any' Front - .- YP ' ' · ...... Depth. ............. Nh ' Height ............... mber of Stones... wi ' ................... ................. Dimensions of same structure th alterations or additions' - ' ' · Depth .................. Height ...... ' ........... 8. Dimensions of entire new construction. Front ""o it / .................... Rear ............... Depth .......... nc ................ Number o£ Stories . 9 Size of lot: Front ..................................... I Rear ............. 10' Date of Purchase ......... ! ................................... Depth ..................... · ' ............................ Name of Former Owner ............................ 11. Zone or use district in which ~remises 12. Does proposed construction violate any Zoning law, ordinance or regulation: .. N; o ..... 13. WiIllot be regraded -. .- ' ' '.' · '.:..' ........... , ......... Wall excess fill be removed from premises: Yes N( 14, r~ame o~ Uwner of premtses O. e...vT.: iq, F,,~ ..... ', · ·. Addresso%'7.q ~.. P. ~,,~'~ ~ t.~a w~t-nxn~00 ~eet 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 frorr property lines. Give street a-nd bloc¢ number or description according to deed, and show street names and indicate whethe: interior or comer lot. CO UNTY,O'F ~/f~.; (Name ~fi m~kWi~:5~'~ gzB~n~ ~%t~c~ .......... being duly sxvom, deposes ~d says that he is the applicant above na~ ~ ~~ ID~i ,~O~iCo. . ,, ' ........................................... _ ~~.~T~j~m~{~ nrractor, agent, corporate officer, crc.) ' ' ol' said o~owners/~uf~ :i~li~nzed to perform or have error ' apphcanon m ~ p reed the sa d work and to m e ' ' · that all statcmcn'ts conta, ned i .... ' ' ~ and file this work will be pcrformcd in the mannc~ set forth ia the application qled therewith. Sworn to bat'ore me this , ~ t, ~ app {cation are trt e to thc best ofliis knowledge and belief; and that the .......... ..... , 19... · ...... - .. . (Signature of applicant)