The URL can be used to link to this page

Home My WebLink About20503-zTOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN? 2050~Z Dote Permission is hereby granted .t_o:~ .../. ....................... County Tax Mop No. 1000 Section ......... ~.~..... Block ......... ~.. ......... Lot No ......./....c~.(.....~../.... pursuant to application dated .......... ,~,~.,.**~.. ........................... , Jg..~...~.'~., and approved by the Building Inspector. Rev'. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined +'"~,¢~ , 19 57.'~ TEL.: 765-1802 Oi pp d / ' sa rove a c BOARD OF HEALTH <.- 3 SETS OF PLANS .......... ~-SURVEY ................... CIIECK ............. SEPTIC FORH .... HAlL TO: . (13mldifig In~tor) APPLICATION FOR BUILDING PERMIT Date ~-W3 19 ~ INSTRUCTIONS a. Th/s 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 publ/c streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll- ation. c! The work covered by th~s application may not be cbmmanced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit mil be kept on the premises available for inspection throughout the work. e. No bu/]ding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy tall 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of bu//dings, additions o~ alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, builsl, i-rlg code, housing code, and re~ula io (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder2 ....... ameofownerofpremises ~z.y.~','v ~..L:~../n/ ~' (as on the t.ax 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 .......... ./?/,/~.0 ........... Electricia,njs License No ........ ,~ ............ Other Trade's License No ......... ¢ ............ Location of land on which proposed work will be done .................................................. llouse Number Street Hamlet Subdivision. l 4o4 ti P.o. iN'¥. /bdev ot.u£ ............... : ........ Filed Map No. · (Name) .............. Lot ............... State existing Use and occupancy of premises and intended use and occupancy ,of proposed construction: a. Existing use and occupancy ) .-~c. ~ i ~e--~te.~. . ......... b. Intended use and occupancy . .. g6',xlex:- . ,.: 3. Nature of work (check which a ' ' Pphcable): New Building .......... Addition ........... Xheratton .......... Repair .............. Removal .............. Demolition .............. Other Worb. ~..~'./~..(~.. ...... 4, Estimated Cost , o , ' ' ' (D ~pti ) ........... ~ ................... Fee .............. 5' v?l~t:p.u?:s:..: ~[ ........ Number of dwelling units on each floor .... J ........... & If business commercial or mixed Accn,,anc- ~.~ ';.;' ' ' :' ','' L .... . ......................... ~ ........... ' ~ ~ y, ~eoaynature/aaaextcntofeachtypeofuse ~J~. .. 7. Dimensions ofexistingstmctures, Jfany. Front ~ .~ . - ~ · ~ t " ' ~ ' ~L'~ ...... Hegel ~t .... Nm ~' " _~ ........ ~ear . ~.~ , Depth ~, .. ~. . · ..... · uuor ol ~torles ..... ~ . . ' .......... ~ensmns of same structure with!alterations or additions: Fro;} ' ' ~ ............................. Depth ........... ~ .................. Rear ................... ........... ~He~ght ...................... Number of Stohes . .. ; .... 8. Dimensions of entire new construction: Front ...... ~]~.'. · · Rear ............... Depth.,. j.". ' '. .. He ,, it . . ~ ' ........... NUmber of Stane~ 9. Sizeoflot. Front ...LO. Sr.91 Il ~ ~'~,~'" ~'~"~'q .................... ~.-~.~ ......... I0. DateofPurchase b'.oq '~ ........... ~ ........~.tr.~ ........... Depth .[~:~. 1 1. Zone or use ~:o,.;~ :_ ~..,'.? ..... .~ ..... : ......... Name of Former Owner .~.~. ~.. l ............ ~ ~,o,,ct m wmcn preml~es are situated... ~. , , , ' ................. 12. Does proposed construction viola,~a-- · , ..... ' .................................... t~l -y zomng law, ordinance or re~t at on 13. Wfl lot be rearaded . ~o ~ ~ ' : .... .............. ....... ~ . ' .' 'M';~'.'.'k:...: ........ Will excess fill be removed from remises ' ~ .... 14. l~mne otuwner olprem~ses ~ ~, ~t~ . , - .... P : Y s x~ .......... ' "'h' ' ............. adaress l~o o~o~ ~. ,, .... , ~6~ i~muu marcmtect . .. ~g~. --.. · ............ v.o.~ ~o .......... .&. .... N~e of Contractor ...... Al} g .... ' .......... Phone No ................ LS. · · · ' ' 'i ............. a'aoress ................... Phone No ................ Ia thm~r~r~Irt~ w~h~ ~00 ifee~ of a tidal wetland? *v~ - .~ ~o, ~oucnoza 'town Trustees Permit may be req~[[}~] ..... ,~o.z> ..... , .... PLOT DIAG~ Locate clearly and distinctly MI buffdings, whether existing or proposed, and, indicate ~1 set-back dknensions propeay Hnes, Give street =d block number or descfiptioh accordMg to deed, and show street nines and ~dicate whether interior or comer lot. FEE: ~BY: ~"~~ 7654802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH * FRAMING & PLUMBING FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALI. CONSTRUCTION SHALL MEEt THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ary Pu blic~.,/.~.: . HEL~NI~ D. HORNS NoIsp/Pu~lto, 8tsto of NsW Yod~ ~o. 49613114 Quallflsd In Suffolk Coun~) 3 .. Commiseloa Explrel M8¥ 2,?., ~9 ,,, :; ~ATE OF NEW YORK,._ _ .(Name of individual sign/ag co~tr~ct) ' ' ~' ' ' we namea. is the .......................... , , ~.-, ........ (~ ag nt offi ) " " ' ontractor, e ,corporate ocr, etc. said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this '{ication; that ali statements contained in tills applicatioq true to the best of his knowledge and belief; and that the rk will be performed in thc manner set forth iJn are the application filed therewith. ~m to before me this .................. day or../~, .ct¢.,..~, .~%, ...... 19 ~'..~_ County "'i/;;k;Jh't3 being duly sworn, deposes ahd says that he is the applicant N. BoO~ - 155.50