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Home My WebLink About20849-z i~OB,~ NO. B TOWN OF $OUTNOLD BUILDZNG DEPARTMENT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N°-N.o 208~$Z Permission is hereby granted to: ..... ............ Fo. .~ ...... ..~... ' ..: ...... L~..~ ..... ,o ..................... .... ~ ...................~' ot premises Io~oted at ............ ........................................... q......~~ ......... ~., ....... ~.~..~. ..................................... Co.n~ Tax Map No. ~000 s~tio...tL.~ ............. B,o~k ........ /.. ........... ~ot No ....... ~f.. ........... pursuant to application doted ................. .?~....~.~.. ......................... , 19..~...~.., and approved by the Building Inspector. //B~ffding InspectOr Rev. 6130180 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..... .~/..~.. ...... 19~..~. Permit No ........... Disapproved a/¢ ..................................... ., (l~ilding Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... 3 SETS OF PLA=tS .......... SURVEY ................... CI1ECK HAIL TOg Date .................. , 19... 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. · ¢. 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 w6rk. e. No building shall be occupied or used in whole orin 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 dmit authorized inspectors on premises and in building for necessary inspections· (Signature of applicant, or name, if a corporation) ..... ueK.. . . . . ............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. lame of owner of premises .ZOmbie..7~.. Pg. ~Bq, V~o,,d ' A~IOVEI) AS NOTED ............................... (as on the tax roll or latest d~'e~*) :_2~ '' ~ 'applicant is a corporation, signature of duly authorized officer· FEE: .¢~.0 · oD BY: ~ ~ NOTIFY BIJILDING OEPARTM'ENT A~ · (Name and title of corpora[e officer) ..... Builder's License No .......................... PI tuber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be'done. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS, 1. FOUNDATION T1NO REQUIRED FOR POUREDCONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION-SHALL MEET THE REQUIREMENTS OF THE N.Y· STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR .... ~.z.~ ./2./.~f. .~.~. T..Z~..~ CONSTRUCTION ERRORS .................... : .......................... House Number Street ...... Hamlet County Tax Map No. I000 Section ..... ././. ~'~..' ...... Block ...... /. ........... Lot .... 02 ./ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended Use antt occupancy of proposed construction: a. Existing use and occupancy ....... /'~.~.~.~...D'~· b. Intended use and occupancy ..... . .~.~.....~. 'e '*~ "41' 3. Nature of work (check which applicable): New Bui/ding .......... Addition: ......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work...t.t.t.,~cP7/1/~,.~ .... 4 Estimated Cost ~..P~.~..lq ~:~ ~ (Description). · ' ' ' ' ' ' ' Fee · (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... If garage number of cars Number of dwelling units on each floor ................ 6 If business commercial or mixed occun ........ '"-- - - ' ............... · , · _ ns,ute eno e tent or cacl type or 7 DimensionsofexistingstrUcturds ifany: 2,~ Front ........... Height Nmfi~er ............... Rear .............. Depth ............. ............... of Stories ' · Dimensions of same structure ,vlth alterations (~i .................................................... Depth ~ additions: Front ................. Rear.. . Height Nam her of Stories ....... e ....... Dimensions of entire new Construction: Front ' "' ' · Height Nmn:ber of Stories ............... Rear ............... Depth ............... 9. Size of lot: Front ....... i R I0 D fP h "· · ........... ear ....... Depth · ate o utc ase ....... ' ....................... i ........... II Z di ictin Ii h'p' .................... Name of Former Owner ................ '. · one or use str w ~ c remises are situated ......... ' ...... 12 Do sp opo ed ti viol~te i ............................................ · e r s construe on any zon ng law, ordinance or regulation: 13 WiIllot bereg ded I ................................ Will fill b ed frsm ise Yes ' No 14' ra ......... , ................. excess e remov m s: Name of O of pr ni ' ' pre · wrier e~ scs Name of A chit .................... Address ....... Pro No r ect .... : ............ ne .............. .. Name of Contra ' ' . ..................... Address .............. Phone No ctor . ' ..................... 15 I thi ty ........... ~ ............. Address ............... ;. ·. Phone No ................ · s s proper within 300 eet of a tidal wetland? *Yes ........ No ......... If y th id · es, Sou o TOwn Trustees Perrai~ may be requi~ed. .... PLOT DIAGRAM' Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror~ property lines. Give street and block dumber or description according to deed, and show street atones and indicate whether interior or corner lot. FATE OF NEW YORK._ . · · ................ being duly sworn, deposes and says that lie is (Name of individual mgmng bontract) the applicant ove named· :.', ' ; ' (Contractor agent corporate officer etc ) sald owner or owners, and is duly adtborized to perform or have performed the said work and to make and file this )lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk wiJl be performed i.n tile m~nner set! forth in the application filed there~vith. om to before me this ~'-// i ' - [~I)IJilW IIJBLIC, ISt~J~j~;~ (Signature of applicant) l~o, 472.5{)89, S~ffolk Term F. xpire, May 31. Lq q,T,~