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Home My WebLink About20163-z l~rOnM ~qo* fi TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~PL~T~ON OF THE WORK AUT. OmZED> Ne 2016~ Z Dot, ....~..~.?..,~. ..................................... / Permission Is hereby granted to: ,~ r / ~ ~ ~..~ ...... ~....~....~/~ .................... ~.T,......./~.,, .......... at premi.s located at ...~...~........-'~.....~..~_......~....--... .................................... ~:z~.¢.....~..~..~._.~..:-- '~' ................................................. ........................................................ ~...~,/~.~.~~ ............................................................................. Coun Tax Ma No I · ~ Block ty p . 000 S ction ...... .~.. ............. B ack ...................... Lot No ........................ pursuant to application dated ...... ¢/./...-~... ..................................... , I~../.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Examined . ., 19~'~.'. Approved ...... , 19¢/PermitNo....~-9..../f.~.?~.// Disapproved a/c ..................................... . ~.(jguil di~.,I/n sP e c t o r ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS ........ SURVEY ................... CllECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: a. Tiffs application must be completely filled in by typewriter or in 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. c. The 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 hal~l 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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to .dmit authorized inspectors on premises and in building for necessaryt,iospection~s., - ..................... (Signaturff,6f applicant, or name, if a corporation) (Mailing address 6f applicant) owner~,0agent, architect, engineer, general contractor, electrician, plumber or builder. Ctate whether applicant is ', ...................... 27/7" ':2.'" ::/_' ': ' ;' ................ Name of owner of premises ~. !t./~-O~L~.....-~...~lf..b~.(~..~,~ .... ~':~a~$:/~ ~. (as on the t,ax roll o; ia't;~i~?~ OE~;~-~' ' ~.f applicant is a corporation, signature of duly authorized officer. (Name and title ofco~. Builder's License No .......................... Plumber's License No. ~ .................... El i i 's Li se N ................... ectr c an cen o ....................... 765~t802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1L FOUNDATION "PC.lO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C,Oo ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ........... ~. CC, DES. NOT RESPONSIBLE FOR Other Trades License No...'% ................. CO ' ,22~.J~N OR CONSTRUCTION ERRORS · ..................... >..~.~..d ~/~:(~v..i. :.'.: ¢74~'..,~,,>cf.?~. :. ................//¢ ~,~,,,....,.::~.,~,., :~¢....'::...~" ,,, ~> / .:. :. ......... tlouse Number Street Hamlet County Tax Map No. 1000 Section ..... ~).'. ....... Block .... 4~ ..... ' ....... Lot ...... f ........... 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 ................. .......................... ;~,:.. ,,~ ~' & ............... b. Intended use and occupancy x:~¢ :~, ,-':' ~M., ~ ~ ._ 3. Nature of work (check which apilicable): New Buildin'g ... '..' ..... Addition .......... Alteration . ......... Repair ........... ,. ·. Remqval .............. Demolition ............. Other Work :~__J~.~_..~. ' ~ ~ ' ' _ ,-~ ~ U(Desc~iption) 4. Estimated Cost ~-~,, i ,- (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars i 6 ' If business ........................................................................ · , commercial or mixed occupancy, specify nature and extent of each type of use 7 ..... if any: Front Rear ..................... · Dimensions et existing stmcture~, ............................. Depth .............. Height ........... Number of Stories Dimensions ;[ ~ ........................................................ me structure wiih alterations or additions: Front ................. Rear ................. Depth .................... [. Height .......... , ............ Number o[' Stories 8. Dimensions of. entire new construction Front ~/t7 Rear ~ i ~e';t~' . . ~ ......... Height .... ~, ......... Number of Stories ..... /' ............................................... 9. Size of lot: Front ..... I Rear Depth .......... 10. Date of Purchase ........... ' ................................. .... ' ........ Name of Former Owner ...................... 1 1. Zone or use district in which premises are situated ..................................................... 12. Does propos,e~ constructio,.lyviol!te any zoning law, ordinance or regulation· ~ . . . 13. Will lot be reoraded ~?.~ ..... Will excess .... ' .... ~'~' .......... ' ............ ~ Name of Architect ........... i ................ Address ................... Phone No ................ Name of Contractor ..... · .,............' .... Address ................... Pr.one No ................ t5. Is th±s property ~:tthin 300 £eet of a tidal wetland? *Yes ........ tl~o~).; ..... · If yes, Southold T~wn Trustees Permit may be re..quired. <.~ ' -'. PLOT DIAGRAM Locate clearly and distinctly all >u!Idings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n umber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. ~TATE OF NEW ~'O'RK,?c[X'~ f/~..- e ~ :ou v °'° (Name of individual signin contract) bove named. ~ . - is the ......................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly 'uthorized to perfom or have perfomed the said work and to m~e ~d file this pplication; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the .'ork will be perfomed in the m~ner s~t forth in the application filed therewith. worn to before me this ~ . ............ . . .......... ~8~' ~ ' ~- ~ . ' ..... ~o.~7~$08 ~ ~ (Signature of applicant)