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Home My WebLink About20747-zTO~N OP $OUTHOLD ~UILDING DEPARTMENT TOWN HALL ~ SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°N? 2074? Z gate ................... ~. ...................... re' Permisslon s e oy g ~.~.. ..... ~......~~ ................................. ~.~ ~.~ . . . ~ .... ~'~ . ~ ~ ~///~ ~ ac d at ....................................... i...~ ..................... : ................................................ ....................................... ~.~ ....... ../..~..;.~ .... ...~...¥~:.>.....~... .............. ............................................ County Tax Map No. 1000 Section .....~,.../. ............ Block ..... ..~..-..~. ......... Lot No. // pursuant to application dated .................. ~//.~.. ....................... , 19...~...~T,.,, and approved by the Building Inspector. Rev. 6/30/80 JUN I B IDD2 Ld" ,,.,', ~'. ] Z -4' 0 FORM NO, 1 : TOWN OF SOUTHOLD : ~'; BUILDING DEPARTMENT '" JUN 81992 ~ ,,, ,,: TOWN HALL l' i~' SOUTHOLD, N.Y. 11971 Examindd'%% '. ;¢o/</. ~.....], 19 .~.'~. Approved ..... : .~//../2 ......19~.bPermi, No . .~. Z~fZ.~. - Disapproved a/c ...... . ............................... ., , (~Silding Inspector) APPLICATION FOR BUILDING PERMIT · J INSTRUCTIONS BOARD OF HEALTII ......... 3 SETS OF PLA?{S SURVEY ................... CHECK : :':' SEPTIC ..... · · .~ 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 )ff areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. ¢. The work covered by this application may not be commenced before issuance ~)f 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 wcrk. 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 luilding Zone Ordinance of the Town of Southold, 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 dm it authorized inspectors on premises and in building for necessary~ (Signature of applicant, or name, if a corporation) ................... (Mailing address of applicant) kate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. APPROVED AS NOTED :ame of owner of premises., b.f~; .¢D¢0.%... ~.E ¢1..0~...~x. [.~... D~'~z~.~ #~ . (as on the tax roll or latest d~'~';U;~Ol'~ f applicant is a corporation, signature of duly auth~orized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ....................... .............. 1. FOUNDAT,O. · (Name and title of co ora e fficer) FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMIB!NG Builder's License No.. .............. ~. INSULATION 4. FINAL CONSTRUCTION MUST Plumber s L'cense No BE COMPLETE FOR C O ALL CONSTRUCTION SHALL MEET Electric, Jan's License No ....................... THE REQUtREMENTS~ OF THE ' STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... i.,Ol%S, NOr' RESPONSIBLE FOR ," / DESiG~ OR CONSTRUCTi0'I~I ERRORS L°cation:,ofland on which proposed work will be'done. . . q?..~..~..~U,/~/(~J tl N b St ................................. ouse mn er feet Hamlet BI k .5.. // County Tax Map No. 1000 Section ................. oc ....... ....... Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use anU occupancy of proposed construction: a. Existing use and occupancy .... ~ .......................... .;. ¥',.' ;,',';< ',' -**~:~'~ ,m b Intended use and occupancy .......................... . ......... ¢~ ...... ¢ 3. Nature of work (check which al~Dlicah)~ ~ ,~, n,. ~ ~ . Re ~ ) .... .: .,e--o~um..g .......... Addition .......... ~teration .~ ....... ,~ p r .............. Rem~oval .............. Demolition ............. Other Work ............... ~ 0 0 '" (Desc~ption) 4 Estimated Cost ' ~ ~O ~ ' . (to be paid on filing this application) 5. If dwelling, number of dwelling]units ............... Number of dwelfing units on each floor.. . If garage, number of c~s .............. 6 If business .... ~ .............. . .................................. · , commercial or mixed occupancy specify nature and extent of each type of use ................ ~ ' 7 Dimensions .... · ot ex~st~ng stmcturas if any: Front .................. ................. Rear .............. Depth ............... Height ............... Number of Stories .......................... ens ns o same structure w aerations or a ns Front ................. Rear ............ Depth ..................... ~. · HeiSt ..... .... Number of Stories ......... 8. Dimensions of entire new constmchon, Front. .............. Rear ............... Depth ........... Height Num]ber of Stories .. 9 Size ............... ' ................................ , .............. of lot: Front .... Date of Purchase ~ .................. ' ' ' ' ' Name of Foyer Owner · Zone or use district in which pre'raises are situated ............................. 12. Does proposed construction violate any zoning law, ordinance or regular on ..................... 13 Will lot be regraded ............................ Will excess fill be remove m premises 14. N~e of Owner of premises ... ................. Address ................... Phone N o...N~e ............. of Architect ..... ~ ..... ..... . ............ Address ................... Phone No ................ N~e of Contractor ......... ; ................ Address ............... ;... Phone No ................ 15. Is th&s property ~th~n 3;00 feet of a t&dal ~et~and? *Yas ........ No...~... · ~f yes, Souchold Town Trustees Permit may be required. ' .... PLOT DIAG--' Locate clearly ~d distinctly ~1 ~uild~gs, whether existing or proposed, and. indicate ~I set-back d~ensions from prope~y Hnes. Give street ~d block umber or description accord~g to deed, and show street n~es and indicate whether ~te~or or corner lot. rATl~ OF N'F~k~OR~6,/~ /~/,.~_ s ou ¥ oF ';, ......... .... . (Name of individual signing contract) ' ' ore named. ....... being duly sworn, deposes and says that he is the applicant (Contractor agent corporate officer ere ) ......................... said owner or owners, and is duly at thorized to perform or have performed the said work and to make and file this :~lication; that all statements containe~l in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner scl forth in the application filed therewith. om to before me this ~, .......... of .... ' ' ' NoMryPubllo, StBteo~n~vYork - Qualified In Suffolk Cgurlty (.//.~.-.-.-.-.-.-.-.-.~.. ' ' 'l .... ~" .... ~' ......................... commission F..xplre~ oe~ml~r 8,19 ~ , (Signature of applicant)