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Home My WebLink About20202-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIl FULL COMPLETION OF THE WORK AUTHORIZED) No- 20202 Z Permission is hereby granted to: ..... ........... ~.~....~.~.~_~ / c~,~ To~ ~ No. moo S,:,o- ....... ZZ.,~... m~k ......... ~. ....... ~ot No ...... ~..~..,~.. pu~uont to appllcotion dot~ ............................................ , 19.~., and opp~v~ by the Building InSpector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 aaminod./.e///. ....... 19 Approved .... /.~/~./. ...... 19 g/Permit No.~..~. .~-..C?., .~./~ Disapproved a/c ..................................... BOARD OF HEALTIt ......... 3 SETS OF PLANS .......... SURVEY ................... OIIECK .................... SEPTIC FORH .............. CALL HAIL TO: ......... APP. RGVCD AS.NOTED ....... / ............... ' .. ~EE' ~ BY: '__~ ._ (~uildin~sp'ector) Nb~IFY BOltiNG oEPART~NT AT ' 765-1802 9 AM ~ 4 PM FOR TH~PPLICATION FOR BUILDING PER~IT ,, FOLLOWING .NSPECT{ONS: 3. FOUNDAtiON '~O REQUIRED D'ate ~ ........ ,19 FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING INSTRUCTIONS 3. INSULATION a.4. ~IkEpplic~R~R~~ly filled in by ~pcwfite? or in ink and submitted to the Build~g Inspector, with 3 ,ct~:of P~X~F~R~.~ to scale. Fee according to schedule. · b.At~jo~~l~ ~E~ and of build~gs on premises, relationship to adjoining premises or pubhc streets )r ir~Ea~g~]~Fd~Bpa~ of layout of property must be drawn on the diagram which is pa~ of this appH- :ati~m~TE CONSTRUCTION & ENERGY c .... c ~N~Wo~ ~plf~ion. may not be cbmmcnced before issu~ce of Bu~din g Permit'. d.o~, ~s~E~ts~, th= ~iZdi.g Inspector win issued a ~uild~g Pe~it to thc applicant. Suc~ ,h~l bc~ ge~t on--the'prcmis~k ~afla'N'wT~inspection throughout thc work. e. iN~ ~gjld.~g_.~ho]~. b'~p~x~i~..p~p~ed i~ whole or in p~t for any purpose whatever until a Certificate of Occup~cy ,hall haVe~b~'e:n ~t~[~y '~%F,-~C~? ~ /~.iv'i 'fO <~ PM FOR THE AP~tq~H ~I.~iE,~[~.MAD~ to thc BuildNg Depmment for thc issuance of a Building Pc~it pursuant to the luildina.~q~.%~X{{~ce.ofl~l~i~outhold, Suffolk County, New York, ad other apphcablc Mws, OrdN~ces or ~egu at o~)i~ro{~p~6~ of bufldNgs additions or alterations, or for removal or demolition, as hcreN described. [he apE~i~{j6~eFa~D~p~ ~plicablc laws, ordinances, bu~ding code, housing code, and regulations, and to tdmit a~ll~_~ctors on premises and ~ buildNg for ncccssa~ inspections. 4. FINAL CONSTRUCTION MUST -BE COMPLETE FOR C.O. ' ............................................. ALL CONSTRUCTION SHALL ME~ (Signature of applicant, or name, ifa corporation) THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY ............................................... CODES. NOT RESPONSIBLE FOR (Mailing address of applicant) S la' DESIGN OR CONSTRUCTION ~RORS . [e whether appuca~[ is owner, ies~ec, agent, architect~eer, general contractor, electrician, plumber or builder. Nam ' /- .' c of owner of premises .............................. ~~ ............................ (as on th~ t~ roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate o~fic,~r/y Builder's License No.~.(-~'].. Plum bcr's Licens6 No Elcctr c an s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done....~...°~f...?.'~..~d ~.d_..----~ ............ ....... O. ....... .,:.. . ... llouse Number Street Hamlet ~. ' . County Wax Map No. 1000 Section .... ./?.7 ......... Block ....... Lot . . . .C~.~.. 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 ........ ~'~' ' ' '~ ,e' ...... -3: ~: ~,k'~v-i? · ~'f:',~" ............ 3. Nature of work (check which ' · applicable): New Building .......... Addition .......... Alteratio . Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ~. .. .,~....~., (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 .............. 6 If business commercial or mlxe:d occupan~ ~;~c'i~y ~a;ur; and extent ~'f'each ty;; of'u~e iii ................. 7 Dimensions of existing structures if Fr'ont · any: Rear ............... Height Number of Stories ............................. Depth ............... Dimensions of same structure ' ' ....................................................... Depth ' wlith alterations or additions: Front Rear .................... :.. Height ................................... 8 Dimensions of entire new construction: ...................... Number of Stories - · Front Rear ...................... Heiglit Number of Stories ............... Depth 9 Size of lot: Front ' ................................................ I0' Date of Purchase ....................... Rear ...................... Depth ...................... II' Zone or use distric~ .......... i .................. Name ofFormer Owner ' · in which pr(raises are situated.. ' ............................ 12. ?.,.o,es proposed construction violate any zoning law, ordinance or regulation: 13. wiulot beregraded . . .. · ................................. ........ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . '. .............. Address . Phone No ........... Name of Architect ..... .................. . .... ....................... Address ............... Phone No. . Nan~e of Contractor ! .............. .......................... Address Phone No .... ,.. 15. Is this property within 3100 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold T'own Trustees Permit may be required· .. , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block rmmber or descriptioh interior or comer lot. according to deed, and dh'ow street names and indicate whether ! OF NEW YOR~o~-. : ........ s.s! (i dual signing ~ontract) ...... bore named. ~ ontractor, agent, corporate officer, etc.) said owner or owners, and is duly ~ ' au,thonzed to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that.fi~e ork will be performed in the manner set forth in tile application filed therewith· ~om to before me this ~,I~Y~4I~ I~ '~, (Signature of applicant) being duly sworn, deposes and says that he is the applicant'