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Home My WebLink About20244-z lt'OI~-M' NO, t 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~ 20244'Z Permission is hereby granted to: .... ~......+.L~...~...~~ .... ..z.~.~..~..~....~ ............. ....~?.~ ............ :~ ........... .~ ......................... ,o ........... at premtses located at .............. ~-~ ........................... County Tax Map No. 1000 Section ....... .~)..~....~.. ..... Block ...... .(~..~ ........ Lot No.....~..:..~. .......... pursuant to application dated .... C~.~.....~.....~.. ................ , 19.~.!..., and approved by the Building Inspector. Fee $ ..................... Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~..,~....o~,.. ?~0., 19~..I.' Approved . . .t~..~. , ~ ,, 19°[.[.. Permit No.q~.. 9..~..q.O/, ..~ Disapproved a/c . ...~.. ~ fl//;, ' ~ (Building Inspector) ' ~APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL MAIL Date ................... 19... INSTRUCTIONS a. Tlfis application mm ompletely tilted in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 o'r public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. 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 shall 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 aoy purpose whatever until,a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicabie laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ha building for necessary inspections. (Signature~ --of' apl~'fcant, or name, if a Eorporanon) (Mailing address of applicant) State whether applicant is owner, less~? architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .~. .......... ?. ............... , .... .~. (as on the tax roil or latest deed) It' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ,z?..~ ~.~., ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ed work w I be done. . . ' ..... ' .................. 1. Locat on of land on w rich propo,s ....... .. }louse Number Street, Hamlet County Tax Map No. 1000 Section ..... ~.~ ......... Block ..... t,.O.."'-'7. ........ Lot..'.~. ~ ...... Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use aud occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b Intended use and occupancy ' ' ' .! 3. Nature of work (check which ~pphcable) New Building ..... ' ..... Addition .......... Alteration . .. ..... Repair .............. Re~oya},. ',kJ.~Jff~'.j ~' .//~De,~,_olitio '' ............. ..... 4. Estimatdd Cost ~ ~.~ ...... ~ ese riga) (to be paid on filing this application) 5 If dwelling nunberofdwelbn~units Number of dwelling units on If garage number of cars I each floor ................ 6. If business, commercial or mixed occupancy specify naa re and extent of each type of L .......... : ......... 7. Dimensions Dfc ngs tu es if any: Front ............... Rear ............... Depth ~ .~ Nu er of Stores .... II~[~i'L ~ ~' ~ , . . ' · · · ....................... alteratmns or additions Front ... ~, ' .............. [[~tn~_: .................. Hemht . [, _.. ;.. . -~.r .................. ' [~~n "~ ' . ...................... ,~umocr ot ~tones ront .... ~ ..................... 8. t~r new c~nstmctmn F xtear ............... Depth ............... 9.~ S~zO~oflot Front ':'~ I ~ -- ~ ................................................ 11 7A ........ j,~~' '~ ................... Name of Foyer Owner ........ ut u~¢ ulsrrlct In WhlCll premises are situa*~ ........... : ................. 12 Does proposed construction vidlate any ~ ~ ....... ' ....................... 13 Will Iht h~ ~ [ ........ ~ .~, urmnance or regulation: ..... ' . 14. Nme of Owner of premises i ......... Will excess fill be removed from premises: Yes No ............... Address Phone No ................ Nme of Architect ......... ~ .................. Address ................... Phone No ................ Nme of Contractor ............. Address ....... Phone No...~ ..... 15.Is this property located ~ithln~O0 feet of a tidal wettand~ ~If yes, Southold Iow~ Irustees Permit may be raqulred. ' PLOT DIAG~M Locate cle~ly ~d dist~ctly ~ bufld~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from prope~y ~nes. Give street ~d block~number or description according to deed, ~d show street n~es and ~dicate whether inte~or or corner lot. . APPROVED AS NOTED ,FEE: ~, ~ , N~IFY BUILDING OEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. 1, FOUNDAT(ON .. TWO REQUIF~ED FOR POURED CONCRETE 2, ROUGH ~ FRAMING & PLUMBING 3. INSULATION 4,, FINAL GONSTRUCTION MUST 8E COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW 5hO~,~ Co u NTY~,OF...~h~.~.' ~.. ,,~,. ~.S (Name of individual signiz!g ContraC~t) above named , (Contractor ............................................... ~ , agent, corporate officer, etc.) of said owner or owners, and is du y!authorized to pe,rform or have performed the said work and to make and file this aPplication; that all statements contaified in this application are True to the best of his knowledge and belief; and that the Work will be performed in the manner ~,~t forth in the application filed therewith. Sworn to before me this ~ .................... or ,, 19 .q.t. ' tary Public ......: ~- . being duly sxvorn, deposes and says that he is the applicant