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Home My WebLink About20432-z 1~0]~,~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20452 Z or,, · Oc o,., ..~ . ~ .~..2, ..~ ............ County Tax Mop No. 1000 Section ........ · .~..2. ...... Block. ......... ~ ...... Lot No ......../..~... ........... pursuant to application dated ....... ~...~. .................................. , 19./.?....~, and approved by the Building Inspector. Rev, 6/30/80 ^pproved. .... .., l S?. ee mit No. ..X .... ............. kOTIFY BUt[DING DEP~~. /W~2 · . · r ~./'. '. <:. m ..... 7654802 9 AM TO 4 PM FOR THE . (Buiid~Ds¢octor) FOLLOWING INSPECTIONS: Abm IPATIn~i FO~ POURED CONCRETE 2. ROUGH., FRAMING & PLUM~ING 3. iNSUL ~lOr~ INSTRUCTIONS FORM NO. 1 TOW~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7651803 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORN .............. MAIL TO: Date Fda- ,-'~ l~ ¢ ~ a.~ 'I~til~s '~l/~]~[~,h~l~ qom~pl¢$1y filled ,n by typewriter or,n ink and submitted to the Bulldog Inspector with 3 sets of:phn]~, ~cg~r[~[' ~ p[~ tg '~t~':~ee according to schedule. :~p] ~*' ' ~ ~ ~/~'~4" (}f~. T '. ........... b._ ~ ~l~,~ocatJo~,f,~(;and of bmldmgs on premises relationsbp to adjoimng premises or pubic streets qr areas ,and gi~mg a ~(d~:~s~np,f~9~ of layout of property must be drawn on the dmgram whmh ~s pa~ of thzs appU- c. The worn cvv*~u ~,lm~avplicarion may not be cbmmenced before issu~ce of Building Permit. d. ~ggE:a, pE[2?~.[~.~a~~e Building Inspector will issued a Bulldog Pe~it to the app~cant. Such pe~it sh~l be kept on the premises available for inspection throughout the work. e. (~.~?p~d~g[~}Z~.~d in whole or in p~t for any purpose whatever until a Certificate of Occup~cy shall havg'~e~ ~~}ctor. APPE~C-A~f0~I~J~ADE to the Bulldog Dep~ment for the issuance of a B~lding Pemit pumuant to the Bmldmg Z~ot~i~lh~e of tfi~OTg~l~¢~uthold, Suffolk County, New York, ~d other app~cable ~ws, Ord~ces or Regulation~(~~t~'~i~f bufld~gs, additions or alterations, or for removal or demolition, as here~ described. The appflc~t~6~ri~lp~t~Hcable laws, ordinances, building code, housing code, and regulations, and to admit au~i[~.~t~etom,on premises an~ m bmldmg for necessa~ inspections. 4, FINAL - CO~STRLICTION MUST (Signature of applicant, or name, if a corporation) .,¢.q x. .q./. ¢. d'. o.~. /. .z.~.z. .¥. . . .~. y. . .//.~. :7../.. (Mailing address of applicant) BE COMPLETE FOR ATL CONSTRUCTIOhl SHALL THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. MOT RESPONSBLE FOR DESIfSN OR CONSTRUCTION ERRORS State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~.~.. ~ ...e,~. ..................................................... . ........................ Name of owner of premises ................. ,...~./..~../..~...~-...~..07..~..~..& .~..~/. ~...f0./.*.,f,~..~k.~J..-~...' (as on the t,ax roll or latest deed) . If 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 ...................... 1. Location of land on which proposed work will be done ................. . ................................. House Number Street Hamlet · Tax No. County Map 1000 Section ....... ~_..... .... Block ............ Lot ........... Subdivision . .Z(~..4~o ZL.. ,~/t.~. ,~...d ............ Filed Map No ............... Lot ............... (I~ame) 2. 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 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVaI .............. Demolition .............. Other Work~. ~? .~K/71/~_~. , , -.. ~O~ /~ 6 ?-~ t~ ~ ~escfiption) 4. Estimated Cost .. ~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling u[nits ............... Number of dwelling units on each floor ................ . If garage, number ofc~s ...... 1 ................................................................. 6. If business, commercial or mixed]occupancy, specdy nature and extent o f each type of use ................... 7. Dimensions of existing stmctures~ if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... D~ensions of same structure with alterations or additions: Front ................. Rear ................ Depth ..................... i' HeiSt ...................... Number o~ Stories 8. Dimensions of entire new const~ction: Front ............... Rear ............. ' Depth ......... Height Number of Stories 9. Size oflot: Front ............~.......... Rear. ............. · · · ..... Depth .... .................. 10 Date of Purchase ~ Name of Foyer Owner I I. Zone or use district in which premises are sit ated 12. Doesproposedconstruct~onvmla[eanyzomnglaw, ordinance or regulation: .~. .......................... 13. Will lot be regraded ... ~ .... ~ .................. Will excess fill be removed from premises: Yes No 14 fP ' Add . Nme of Owner o remises .... i ................ ress ... ................ Phone No ................ Nme of Architect ' Address Phone N0 Nme of Contractor .......... ................ Address ................... Phone~ ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No...~ ..... · If yes, Southold Tgwn Trustees Permit may be required. ~.. ~ PLOT DIAG~ Locate clearly and distinctly ~I ~uild~gs, whether ~xisting or proposed, ~d, indicate ~I set-back d~ensions from propegy lines. Give street ~d block n~mber or description accord~g to deed, and show street nines and indicate whether interior or comer lot. ~ / STATE OF NEW YORK, , ..... ~.. · · ~'~ ~ ~ .... ~. ~ ~,c. ~ ......... being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) [bore named. is the ......... (Contractor , agent , corporate officer , ere . ) )f said owner or owners, ~d is duly ~uthorized to perform or have perfo~ed the said work and to m~e ~d file this pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the york will be perfo~ed in the m~ner s~t forth in the application filed therewith. ;worn to before me this ~0 ~7~5089 8un0[k ~ .............. v,,~.~ rx~ ms ~a~ 31, 1O~ (Signature of applicant)