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Home My WebLink About20744-z lvO~ NO. II TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT Cr'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N? 20744Z Permission is hereby granted to: ...~..~ ................. .~.....t. ....... /~~ ...~s~.,.../..~.~ ,~. ~ ....................... ~...........cL~. ........... ...~..~ .......... ~ ............, ,o.~..,.., ....... ~ ................. ~ .. ~.-.....%.~m~_ ~. ~ at premises located at ~..~...; ..~. ......................... ; ....................... County Tox Map No. 1000 Section ...... .C~..~..3 ..... Block ...... (~.~.. ....... Lot No.....1~..~ ............... pursuant to application dated ........ ..~...~......L.~.. ............... 19.~...z~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Examined ...~.,~4,~... ~ .~.., 19 ~..z-- Approved ...J. 1.+,~.. J.~., 19 ~.a,. Permit FORM NO. 1 TOWN OF SOUTi~,OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .... . ....... ' _ (BuildingInspector) APPLICATION FOR BUILDINGPERMIT · I INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLA?~$ .......... SURVEY ................... CIIEEK ............ SEPTIC FOR,I ........ a. This application must be completely filled in by typewriter orin 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 Dr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :orion. c. The work covered by ttfis 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 w6rk. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy hall 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 regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ;he applicant agrees to comply with al/ applicable laws, ordinances, building code, housing code, and regulations, and to ~mit authorized inspectors on premises and in building for necessary inspections, , ',q -- (S0gnature of applicant, or name, if a corporation) (Mailing address of al~plican0, t \ c.j 9 ) :tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. P. 4 d- L ................................. lame of owner of premises,. : v-~ . (as on the tax roll or latest deed) 5applicant is a c, orporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License Nor<~. I~ ~-'/'-7 - ~'~ Plumber's License No ......................... Electncmn s L~cense 'No Other Trade's License No. Location~of land on which proposed work will be'done. ................. ....... i'"i"i'"i'i' House Number Street Hamlet ty T ' Court ax Map No. 1000 Section .............. Block ....... Lot .... Subdivision V'V' l .................................... Filed Map No. Lot (Name) ....................... State existing use and occupancy of premises and intended use anti occupancy of proposed construction: a. Existing use and occupancy ...... <~' (~ ~-e_ '~ .v&>~ \ .~ kt~.e)v~x ~. · nten e use an occupancy ........ . . ~ ~.: ,,, ..... · 3. ature of work (check which applicable): New Building ......... Addition .......... ' Repair ........... Rem'oval r-, .... Alteratmn .......... ' ' i ..... ' ........ ~,emounon .............. Other Work. ~.,...,a ...... " i .......... Fee .............. 5. If dwelling, number ofdwellingiunits ..... ~ ......... (to be paid on filing this application) Ifgarage number ofc~s ~ Number of dwelling units on each ~oor ................ 6 If business commercial or mixe~ occupancy s ' ' · , pecff ....*--e and extent of each type of use 7 Dimensions .... ~ · et exmtmg structures if any: Front ..................... Height Nm~ "ber of Stories ........... ' Rear ' ' ' Depth D~ensions of same structure w~th alterations or additions: Front ................. Rear ..... Depth ....... . .... ...... ,.. Heist ................... Number of Stodes ......... ~,~.~ 8. Dimensions of entire new construction: Front ........ ; ...... Rear ............... Depth ............. Height ~um~ber of StoHes 9 Size .............. ~ ................... , ................ Depth l0 Date of Purchase .......................... ' ' Name of Foyer Owner ' 1 I. Zone or use district in which premises are situated 12. Does proposed construction vie e any zoning law, r c 13. a n: .... ~ ................ Will lot be regraded ..... ~ . 14. ' ' '~ .... c ......... Will excess flu be remove~ ,fr~m premises: Yes No N~e of Architect ......... { ............. Address ................... Phone No. N~e of Contractor .~%q .................. Address I:~q .~j.~ E,~ 15. Is this proper~y within 3~00 feet of a tidal w~tland? *Yes...'~.. No. · If yes, Southold T{own Trustees Permit may be required/' ......... PLOT DIAG--' Locate clearly ~d distinctly MI bulldogs, whether existing or proposed and. indica e prope~y Hnes. Give street ~d block ~umber or de~;~- . .... , . . t ~I set back d~ensions from ~tefior or corner lot. i ~--~ ..... accoramg to aces, ann snow street n~es and indicate whether APPrOVeD AS OTfD · N(YriFY ~[J~[D~N(~ /)~PARTMENT AT 765-~O2 9 P,M ID 4 PM FOR THE 1. FOUNDATION FOR POURED CONCRE~ 2, ROUGH -, FRAM{NG & PLUMB{NG 3. }NSU~TION 4. FINAL CON~]:RUCT{ON MUST B~ COMPLET~ FOR C.OL ALL CONgTRUCTION SH~LL THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION ~ ENERGY ' (Coutractor agent corporate officer ' ' ' ~ .......................... said owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file this '}l~cation; that all statements containe~ ~ this application are trne to the best of his knowledge and belief; and that the w~l be performed in the manner sci forth in the application filed therewith. om to before me this I ' Nota~ ~bllo, Smte of N~ Yo~ d. Term ~irea June 12, 19~ I