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Home My WebLink About20356-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20356 Z Permission is hereby granted to: ..~..~~..~.~._.~.: ................ .... ..~....~......~......~o ~ o ........................................... .~.~ .......... ~ ........ ~.~.~..~ ....... ,o .~.~....~. ......... ~.' ..,...~. ..... ~ ............................................. ~. ....... ....................................... ",'".' .......... '_"-J~'~'"'":7": .......... ~ .............. .-75 ............. : .......................... at premises located at .../....~....O.......(~.~.....Y.~ .........~..~..o~....: ........ .J..~ ......................... County Tox A~op No, I000 Section ,...~...~...~. ......... Block ...... ..~.....~.. ....... Lot No....~....0. ................ pursuant to application dated~.~..~~......-~....~. ......... , 19..~.1.., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 BEC 2 6 ~99~ EXan'dncd~ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-]802 (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... 3 SETS OF' PLAN!i . . ........ SURVEY ................... CIIEcK ............... SEPTIC .............. .~..'Z~.-.<', '~- ........ .z:->.r: ?.~?X TO: Date ~¢7~-~,d~ lV~.~ r INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to tlie Building Inspector, with 3 ~'t~ 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 publio streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. ¢. Tile work covered by this application may not be Cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~all 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 ~all 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 ailding 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. im applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary i7~p/cn~. , · :. .............. " / ~,~/-)~" /(,6ignature of applicant, or name, ifa corporation) ' .. (Mailing address of applican6 ~" ..... :ate whether applicant ~s owner, lessee, agent, architect, eneineer, general Contractor, electrician, plumber ~/Lb~ ~ or builder. or owner of ................................................ (as on tile t,T< roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · , · Builder s Lmense No .... -; .................... Plumber's License No ........ '. ................ Electrician's License No ....................... Other Trade's License No .............. Location of land on which proposed ~vork will be done..' ........ . llouse Number Street ....................... Han~le, t County Tax Map No. 1000 Section ...... /.~...~.. ....... Block .. //~ - Lot ................ .... SubdM~ion ...................................... Filed Map No. I~" ......... (Name) .............. Lo ....... State ex/sting use.and occupancy of premises and intended use and occupancy of proposed construction: /~.e..4. 92 ?,,;e e. a. Existing use and occupancy .......... b. Intended use and occupancy 3. Nature of work (check Which applicable): New BuUdin~ ...... Addition .......... Alterat[~ ~; ;..~.. Rep:ur .............. Remoyal .............. Demolition .............. Other Work. "/'L~' ' .~q..c..~rx' . ' - /3,0.01 ' ' (Description) 4. Estimated Cost 5. If dwelling, number of dwelling ulnits (to be paid on riling this application) · If garag~ ............... Number of dwelling units on each floor ............... , number of cars ..... ,~ ............ , .... . ................................... 6. If business, Commercial or mixedioccupa ~cy, specif natu ' . . 7. Dlmenslonsotexist ~gstmctures~ fa",, '"---. Y re and extentofeachtypeofuse }to gilt . . ~,, ~, ~ ........ · · Rear ,*, .. ' r,. . ' ........... ~'mm~er otStor es ........ ' ............. ucpln ........... ulmenslons of same structure with alterations or additions: }7'rollt ........ · · · · Depth ....... . ................. Rear... .............. ,'. lleigbt ......... · ............. ' ' ' ' ....... Number of Stories ....... 8. Dimensions of entire new constmbtion: Front ' . ........... igt b~ fSt ............... Rear.· Depth He tt ............. Num r o ories ................... 9. Size of lot: F?ont ........... ' ................... ' .... .' .......... Rear. ................................. I0. Date of Purchase ......... . ,. . ..... · · · ' ....... · Depth , ' .............. marne of Former O " .................... I 1. Zone or use district in which prcm~sesare situated wner .................... 12. D ........... ' ........ t? gl ................ · ......... ocs proposed constructmn viola any zonin aw, ordinance or re,, ' · ' ......... ' ' ' ' 13. Will lot be regraded i omanon: .... 14. Name of O~vner of nr~m;~ Wdl excess fill be removed from premises: Yes Name of Architect , ' ............ Address ........ o ............ i. · · .Phone No .............. lance of Contractor .......... ' ........... Address ................... Phone No ............... 300 f ress .. '9 ............... ' l 5. ~ ............... Add · Phone No ......... .. s ~hi$i~r;perty within eat of a tidal wetland, ayes ........ No ....... '''' ~ · . · es, Southold To n Trustees Permit may be required. ' ' .... PLOT DIAGRAM Locate clearly and distinctly all b~ildings, whether existing or proposed, and. indicate all set.back dknens/ons from property Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. rATE OF NEW YORK, I:OL,L (3~diVG INSP['C I I()~W,~ I, FOUNDAI'FF.)N I'W(; HVfh2j' D FOR POURED CONCRETf,: 3. INSU[ATtON 8~: COMPI.[:'F~ FO[¢ C.O ALl. coNg'raucrtoN SHALL MEET CODES, NOT RESPONSJBL~ FO~ OESIGN OR CONSTRUCTION ERRORS (Name of individual signing co{ttract) being duly sworn, deposes and says that he is the applicant : is the , ~contractor agent corporate officer etc) ................. said owner or owners, and is duly aoth~rized to perform or bare performed the saki Work ~nd to make and file this :d/cation: that all statements contained iff this application are true to the best of his knowledge and belief; and that the rk wdl be performed in the m~ner set forth in the application filed therewith. om to before me this a~a~ Public, State of New York / / ~ ' ..... ,~rm ~:xp~res Uecember 31, 19~