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Home My WebLink About20676-z l~OR~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE K:EPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK: AUTHOP, IZED) N °.°-N? ~0576Z :::::::::::::::::::::::::::::::::::::::::::::::::: ................... .~./..~ ...~...~z..~... ~ .... pursuont to application dated ............ ...,~../~....~.. .......................... , ]9...~...',~., and approved by the Building Inspector. Fee $.....~.....~...x.~ .... /~/Build~ng Insl:~ctor Rev. 6/30/80 HAY ~6 ~9~ 09:39 TOWM OF SOUTHOLD Examined .... Approved ... FORM NO, 1, TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... Z ... J(~tildlng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. Tile work covered by this application may not be commenced before issuance of Bui/ding Permit. d. Upon approval of this application, the Building Inspector w//1 issued a Building Permit to the appflcant. Such porn 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 any purpose whatever until a Certificate of Occupan. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the COnstruction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectorS on premises and in building for necessary ins tion --' (S~gnature of al~licant, of name, if a corporation) (Mailing address of applicant) State whether applicant i6w~er)lessee, agent, 'architect, engineer, general contractor, electrician, plumber or builde (as on the tax roll or l~tt:N'e~ LD NG DEPARTI~ENT AT If applicant is a corporation, signature of duly autt?rized officer. 765-1802 9 AM TO 4 PM FOR THE · FOLLOWING INSPECTIONS: .... 'L FOUNDATION ~ TWO REOUgRED .............................................. FOrl POURED CONCRETE · (Name and' title of corporate officer) 2, ROUGH ~ FflAf~ING · PLIJMB~NG 3. INSULATION Builder's License NO .......................... 4. FINA~ COflSTRUCTION BE COMPLETE FOg Plumber's License No ......................... ALt. ~ONSTRUCTION ~NALL MEET TNE F~EQUtREMENT,S OF THE N.Y. EJectn~ t n s L~cen~e No ....................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR Other Trade's LJcense No. .,..~................ DESIGN OR CONSTRUCTION ERRORS ltouse Number Street Hamlet County Tax Map No. 1000 Secdon ....... /! ~' 00 Block .,-~ .. Lot .~.... Subdivision.., ~..0..~. ~.. ......................... Filed Map No ............... Lot .............. (Name) 2. State existing use ahd occupancy of premises and intended Use an~l occupancy of proposed construction: MAY 26 ~92 09:40 TONN OF SOUTHOLD 3. N~tUre oF wo'rk (cheek ~h~eh ~l~e~h~ ......... ' ' ~ --- ...... .: ~ew ~u~mg .......... Addition .......... Alteration . ........ RepOt .............. Removal .............. Demolition ............. 4. Estimated Cost...' ese on . , . ' tG'~ (to be paid on filing this a. pplication) $. ![ owelhng, number of dwelling ~:I~its . _ ~.. Number of dwell:--- u .......... ~ n~ on eac~ Hoot · 5 ~, ~.~o~ or ~ .... ~.0..¢~~. ~. ~.tt~&~. . ' ....... 6. l, oualness, commercial or mixed occupancy, speciy nature a~d extent ofeac~ t~p;'df~;;e':::: ::: :::: ...... 7. Di~ensionsofexisting$t~ctutes, ifany: Front ............. ~. Rear ............... D~ens,ons of same structure with alterations ~i[iins: ~]r~; ~ ........... Rear ... ' D~pth .................... ~ei~ ~ ~' ~,,~h~. ~c ~- ' .......... 8. ~imcns:ons oI entire new const~c~nt . .~.~ ....... ~ ........... 9. Size of lot: Front ...................... ,Rear ...................... ¢ h .... ,0. .................. ..... ·, · ' ........Name of Fo~¢r Owner .... hp ..... l 1. Zone or uso district m whtc romtses are $guated ................ , ........ ' .... 12. Do~sproposedconstructionviolateanvzonin. law ~-~: ....... N~e o~ Contractor .......................... Addre$~ .................. ~one No .... ' '~ 15, I~ ~his property within 300 feet of a tidal wetland? ~Yes ....... F~d3 ............ · If yes, Sou=hold Town Trustees Permit may be required, ~ ........ ..., PLOT DIAG~ Loca~ deafly ~d distinctly ~1. bufld~, whe~er ex~$ting or proposed, m~d.]ndicat~ ~1 s~t-back d~unsions from prop~y Nn~s. O~va stro~t ~d block number or desc~pt~on'aooord~g ~o d~ed, and show street n~os and indicate whoth~r ~t=~or or corner lot. STATE OF NEW YORK ...... , :ou = .......... ' ................................... being duly sworn, deposes and says tha~he is the applicant (Name of individual signing contract) .lbove named. ~:::~ :',Tmc: ........... % ~d it.duly authorized to p0rform or have perfo~ned th~ said work and to m~e ~nd fil~ this mplmdon: that ml statement$ co,rained i~ thi~ application are true to the best of l~nowl~dg~ and b~llef; nnd that the · york w~l be performed in th~ re=her sot forth in tho application filed therewith, ~wo~ to beforo me this ' ~. 4911757 _ ~ m S~ ~U~W ' ' ~ .............................. ~ ~m ~m~ ~, 1~ ....... HE'v,/ SUFFOLk< P. OAD 3Ol,9l IQ Z 1= ~.6 30C0 W. HA~TUNG 301,~) I0 ~OL,P NAR ~01~