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Home My WebLink About20748-z l~U~ NO. B 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) N~N.° 20748Z Permission is hereby granted to~ . ....... ~.~,..~..o~...../.~ ................................... ...... ~~< ........ ~.,.~ ......... ././..~.~.;~. _ ,o ...... .~..o.~..sz:~.~..~.~. ........... ~ ........ /.....4~.~:~ ..... ~£ ...... ~./...~..../~.~.....~... County Tax Map No. I000 Section ...../..~...~.. ........... Block ...... ...~....~... ...... Lot No ......... Z...~.. ......... p, rsuant ,o application dated ................ ~.././.....~.. ...................... , 19...~...~.., and approved by the Building Inspector. Building InsDector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1802 Disapproved a/c' . ..... , ............................... ., (Buil~ng Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... .... 3 SETS OF PLANS .......... ~SURV£Y ................... --CIIECK ' .... :':Z'Z ': '" SEPTIC ......... House umber Street Hamlet ............ County Tax Map No. 1000 Section ...).¢~ ......... Block ~. Lot //. . . Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended Use and occupancy of proposed construction: a. Existing use and occupancy .... ~ ' T/ / - '£ .... ~ ............. ~ t.5;~0~ ~;~ A4 ~7';'~'A, ........ b. Intended use and occupancy .......... " ........ '~' ............... j,~? ,~.'~ '~.~r~% ~,~,z:.~ ;'m~+ ...... (Name and title of corporate officer) u. , . .2..%...¢./- f.... B ilder s License No.. . .... Plumber's License No ............... Electrician's License No Other Trade's License No ............... Location,of land on whi.ch proposed work will be'done.. FOLLOWING INSPECTIONS: I. FOUNDATION TWO REQUIRED FOR POURED CONOREYE 2. ROUGH FRAMING & PLUMBING 3. INSOLATION 4 FINAL CONSTRUCTION MUST F;F COMPI..~TE FOR C O ALL CONSYRUCTION SHgI~L MEET l"-fr R~LIIRE~4ENTS~ OF~' tNE 'N Y. '"'cS ;qO7 . RESPONS!BL!~ FOil ....................... :.. %~%. ~.. ~ ' J INSTRUCTIONS /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 >r 'areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. o. The work covered by this 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 work. 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 ,%ulanons, for the construction of buildings, additions or alterations, o~' for removal or demolition, as herein described. 'he .applican.t agr. ees to comply with all applicable laws, ordinances, building code, housing code, and reoulations an dmtt authorized mspectors on premises and in building for necessa,.~.~;ct,~io,_,,n~. .--?--. , d ,o ppuc. ant,. or name, ii a corporation) :rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ~uilder. ( n the tat,-,'foll or latest d~lFy BUILDIN6 Db'P~ f applicant is a corporation, signature of duly auth, orizcd o£flccr. 765-1802 9 AM TO 4t PM FOR THE Na u · ! ·'' . 3. t re of work (check whzch a~>phcable): New Building .......... Addition . .~.~--w; . 3clt~rat~0a,~, ........ Repair ......... . ..... Removal ............. Demolition .... ; .~... Other Wor~k~~.. 4. Estimated Cost ../~ _ ~ ....... ~ (Desc~ptmn). / ~ . · .... eec ...................~ ............ . . (to be,prod on fihng this application) 5. If dwelling, number of dwelling ~units....~ ~ .... Number of dwelling units on each floor ...... . If garage, number of c~s ' · · · · 6 Ifbusi c cialo '"' '~ ............................................................. ' do y specify and f htype f "'~ ' ness, ommer r mlxe ccupanc nature extent o eac o use . 7 Dim ' sof ' 'ngstmctur~s ifa ' · e~slo~ eXlStl ~v. Frnnt ........... Eg t.. .............. s r ;rT-'t 'jj;'tjj' j .............. ..... ~ mer o es. . . ' .... sofs mestmcture ]th Itc tio oradditi ..... ~enslon a w a ra ns ons: Front ................................. ~ . · ................ Rear ............ 8. Dimensions ofenhre new const~ctmn: Front ............... Rear ............... Depth .......... Height Num'ber of Stohes ...... ' ............. .............. , ..................... .......... ~ ........... Rear ................. Depth .................. ~... I0. Date of Purchas~ ..... -: . ................. ~ame of Foyer Owner . 11. Zone or use district in wine *rem~ses are situated.. ' ........... 12. Dues proposed construction rio . e any zoning law, ordinance or regulation: ..... " ~ .... ar~0 ........... "" 13. Will lot be regraded ............ Will excess fill be remove m premises: ~ Yes No 14 Nme of Owner ofprenrises ' ' ' '.' · ~ .............. Address ......... Phone No ................ N~e of Architect . . ~ ' ' ' ......... .... . .... ~ ................ Address ................... Phone No ................ N~e of Contractor ....... 4 ...... Address ............... ;... Phone No ........ 300 f ........ [5. Is this property within eat o~ a t:tdal wetiand? eyes ........ No ......... · If yes, Sou~hold Tpwn Trustees PermtC may be required. · ... i PLOT DIAG~' Locate clearly ~d distinctly ~1 ~uild~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block ri[umber or description accord~g to deed, and show street nines and indicate whether ~tefior or corner lot. FATE OF NEW YORK, 3UNTy OF ................. S.S ....... ' ........................ being duly sworn, 'deposes and says that he is the applicant · (Name of individual signing contract) ore named. - : ls the ' I~' (Contractor agent corporate officer etc ) ....................... said owner or owners, and is duly atithorized to perform or have performed the said work and to make and file this '>lication; that all statements contained in this application are trne to the best of his knowledge and belief; and that the rk will be performed in the manner seti forth in the application filed therewith. om to before me this I - ..... ..... ' WFub~l~8~eo~NwYMk ...... /..v:~..~tr~.l .... /.. :).~.. ,.....~'.. ao.~.eBu~e,s,,ffo~__com~_ / ' t /~..../--'.~. . ; ........ T~'r~ ~ J~ I~, I~.,~ / ~ k~tgnature oz applicant)