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Home My WebLink About20406-z I~OB~ NO. ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PEP.~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~ 20406 Z Permission is hereby granted to: ....... mt premi,es located at ..... ~~,..~...~..~.~...~-~.....~... .................................................... County Tax Mop No. 1000 Section ...... .~...~... ...... Block ...... Z ............. Lot No .....~ .......... pursuant to application doted ......... .....~_~ ....... a~.....~..~Z........., ,9..~.~e~.ond approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD ' BUILDIN(~ DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................. 19... Disapproved a/c ..................................... BOARD OF H£ALTll 3 SETS OF PLANS .......... SURVEY ............ SEPTIC F 0 R,~! .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Tlfis 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 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 c~mmenced 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 work. e~ No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy zall 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 uilding Zone Ordinance of the Town of Sou,hold, Suffolk County, New York, and other applicable Laws, Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :lmit authorized inspectors on premises and in building for necessary inactions. ~-"~'D ..... ........ -- (~_j~'ature of applicant, or name, if a corporation) ........ (Mailing address of apl~licant) . _ .. '.,ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ptumber or ouflue~?/ ~ame of owner of premises j ~,,/F/~:-~r~-~,~ .... ~.,. ..... .< . ,~.~.~.~.~.~.~.~. ,'. , .~r~. ................. (as on [[lx~ta~x roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location oflandonwhi~hproposedworkwillbedone ~.~.~.ff ~..~...~?~....~?. '~. ~ ~-- ~._ ~ ,' ? '""_ .. ........... ~,..· .... ........... ........ ................... House Number Street Hamlet County Tax Map No. 1000 Section ...'~.~. ........... Block . ..ff.. ......... Lot ~'~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constr?ction: b Intended use and ~x'~- ~ ~'%- ('/J ..... "~ "" :"(~ .... : ....i ...... · occupancy ..... ~.~:- .... , ............ , . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........... Repair .............. Removal .............. Demolition ............. Othe~rk .t~ .-~f~. ~ .a~r.,~ ~ ~cription) 4. Estimated Cost . .l ,~..~..~.~. ~'/ ' Fee ...,~..~"...,~ ..~..~.. : (to be paid on filing this application) 5 If dwelling number of dwelling ]nits Number of dwelling units on each · , U, ' .............. floor If garage number of cars I ................ Ifb dI ify usiness, commercial or mixe occupancy, spec nature and extent of each type of use ..................... 7. Dimensions of existing stmctureslifany Front . ' Rear ' De""' " ........ Height ............ Number of Stones ........... Dim i ith dditi Fr ens OhS of same structure w alterations or a OhS out . D pth ~ . ' ...................................... e ................ ~. Height ...................... Number of Stories .................... 8 D' ' ' pulc · · · lmenslons of entire new const tion: Front ............... Rear..... ........... Depth ............ Height ............... Num !er of Stories .................... 9. Sizeoflot: Front J ..... J'l~;;i~':::JJjj ............... 10. · ................. Rear ................. . .............. Date of Purchase Name of For net ,~, , . .,. .......... 11. · . . . ' ....~ ................ uwner ................ Zone or use district in which premises are situated . . . . 12. Does proposed construction violale any zoning law, ordinance or regulation: ...: i : i ............ 13. Willlot be regraded ......................... .......... [ .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... !. Address ................... Phone No. . . Name of Architect ............. Address Phone No Name of Contractor .................................................. .......... i ................ Address ................... Phone No ................ [5. Is this property within 3~0 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all biuildin~s whet o, nm exlsung or proposea, ana, inaicate ali set-back dimensions from property lines. Give street and block number or descriptioit according to deed, and show street names and indicate whether interior or comer lot. . TATE OF NEW YORK, OUNTY OF ..... S.S "'~-'~'/X/~--'~' · ' '~' ~'~' ~'~.~. ............. being duly sworn, deposes and says that he is the applicant (N me of~ndlvldual roguing contract) rove named. is the I (C to agent rpo offi ) ....... ontrac r, , co rate car, etc. · said owner or owners, and is duly adtborized to perform or ha~,e performed the said work and to make and file this plication; that all statements containe~ in this application are true to the best of his knowledge' and belief; and that the ~rk will be performed in the manner se~ forth in the application filed therewith. ~om to before me this Qualified In Suffolk COUnty ~:~.,/-~ .( ~.~ t g ature ot appncam) Commission Ex, ires May 22, 19 FENCE License No. 7541-HI Robert Bohn Contracting P.O. Box 55 Peconic, NY 11958 (516) 765-1119 Rep. Bob Bohn Rep. Jason Leonard All material is guaranteed to be specified, and the above work to be performed in ~ccordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: ~ Dollars ($ ). with payments to be made as follows: ~ ~, (~0~ ~ '~ g~h~3C~ ,OJ~ aA c~.o~Pce'Tto~J Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contin- gent upon strikes, accidents or delays beyond our control. Owner to cany fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work taken out by Date Date Note- This proposal may be withdrawn by us,if not accepted within ~'~ days. ACCEPTANCE OF PROPOSAL Signfitm'e~