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Home My WebLink About20729-z FOB~ NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~°-N? 207~1Z Permission is hereby granted to: .~ ~ ~ ........ ~.~.../.~:..~....~~ ..... ,o ...... ~~.......'L...~'"'"iii~/.'.i~'.'"..'~..."-~ii~ii~.~i~iii~ .... ~... ................ ~...~.....~~..L~.~/ ..... ~ ~ ........................................ ~ ~ ........ .. ~ ~em,..,~d ~ ................................... ~/~))//~ ......................... ~ .......... ~....:. .............. .................................................................. ~~.~.~:. ....... ~:.~.: ..................................... Co..~ To~ ~op ~o. ~0oo Se~.o.....~ ........ ~,~k ...... ~ ........ ~ot .o ..... ~.~ .... Building Inspector. ~ee ~.~ ...... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined .......... ,19, Approved .......... 19~.'.ZTPermit No. ~7..~.~?..~. ~7 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... -~3 SETS OF PLANS .......... -~-SURVEY .... SEPTIC FORH CALL ................... HAIL TO: a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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- :ation. 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 ;hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ,liall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law% Ordinances or >,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmit authorized inspectors on premises and in building for necessary)rCpections. ~ · ......... -- (Signature of applicant, dr name, if a corporation) (Mailing address of applicanO (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electri~ian's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... &L~..~...~:=.. ......................................................... ^P.~.~ Olff, D AS. ~OI[D ...... ~-~ -- ~ .,~ /~O.r~.~ ...,~'~/NF_~;~'-'' DATE:~B.R Name of owner of premises ./../7/../../2'7.~../q../.~.c. .............................. ~.~x~,~.~/~ ....... ~. --v..~~,. .-,~0 - ~ BY: ~' - (as on the tax roll or latest.....cr~ BUILDING 0~~-~ If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4, PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS t. Location of land on which proposed work will be'done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ~4Z-5'-- Block . .~. ff. Lot d2)~-' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy./..~..~.~. 10. 11. 12. 13. 15. property lines. Give street and block number or description interior or corner lot. Nature of work (check which applicable): New Building .......... Addition .......... Alterati.~j~ ... ~ ...... Repair .............. R~m~val .......... Demolition ............. Other Work..~...~..C..~ ..... ................................ Fee .... ~ ................................ ( o be paid on filing th~s apphcatmn) ' / / If dwelling' number ° f dwelling iunits .............. Number of dwelling unRs'on each floor ............... If garage number of cars · If bus~ne'ss · .... · ' .................................................................... , commercla or m~xe~l occupancy, specify nature and extent of each type of use Dimensions of existing structures if an,,' Front ..~9 · · ................. Rear .~.~ De th Height . ..~.0. ~.T ....... Number of Stories /. ;'/'~ P ' ~ ............. Dunensmns of same structure w~th alteratmns or ad&hens' Front '~. . · Rear ~ ...... Depth ':-. Hei,ht .............. · ....... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Num'ber' of Stories Size oflot: Front.....' .............i ... Rear.. Depth .......... Date of Purchase /._/_e .~f/ I .................... · ........... .......... ......... ' ......... Name of Former Owner .~. V,,o,~ ,~ 7-/~-~' Zone or use district in which prdmises are situated ....... constructmn violate any zoning law, ..................... ' ......................... Does proposed . . I ordinance or regulation: . ..~?. ........................... Will lot be regraded ....,'~.q... i ................... Will excess fill be removed from premises: Yes No fp . Nme of Owner o remIses ...I ................. Address ................... Phone No ................ Name orA hit " rc eot .......... ................. Address ................... Phone No ................ ~ ...... Address ............ Phone No. Name of Contractor .... ...... , ........ Is this property wxthin 300 feet of a tidal wetland9 *Yes . - ~ .............. · If yes, Sou~hold ~own Trustees Perm±t may be regu±red. .. , PLOT DIAGRAM Locate clearly and distinctly all lbmldmgs, whether existing or proposed, and. indicate all set-back dimensions from according to deed, and show street names and indicate whethe,r ~TATE OF NEW YORK, I ~OUNTY OF ...... S.S ...................... gd ly ......... i .................. bein u sworn, deposes and says that he is the applicant (Name of individual signing, contract) bore named. ~ le is the ' I (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this pplication; that all statements contalnled in this application are true to the best of his knowledge and belief; and tliat the 'ork will be performed in the manner s~t forth in the application filed therewith. worn to before me this ..... , 19 ~.~. . ~-r',6 ' . ......... / .......... day of..i..-~,fx,~. ..... Pub,c, . County Notary Publlo, State of ~New ~r~ No. 4149~257~ I ........ . ....... OuaBfied in Ou~ena C~n~ ~ ~ ' ............ ~mmls~on Expires July , 1~ ~ (Signature of applicant) '\