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Home My WebLink About19725-z ~wOmW NO. $ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 19725 Z ,o_~~....~ ......... ;~ ........ ....-~.~~.~.~ ......... ~ .............. ...~~.............~.: .................. ._....~ ............. ~. ......... .~..~ ................................................ et prem,ses Iocoted at ...~.~ ....'~.. ~ ....~..~ ...... County rex Map No. I000 Section ..... ,/,./.~ ......Block ............. .~'... .... Lot No..../~.... ................ pursuant to application dated .......... ~ ................................. , 19..~/..., and approved by the Building Inspector. Fee $.....~.... Rev. 6/30/80 Mt~TTIT41¢R, Al. Y. :J tooo ~ ti'q- "~ - 7. FORM NO. ! TOWN OF souTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHQI. D. L~.'~ .. L[q7~ APPLICATION FOR BUILDING PERMIT 3 SETS OF PLAYS .......... SURVEY ................... ClIECK .................... $£PTIC FORH .............. CALL ........... ~ ...... NAIL TO: IN', t I~.UCTIONS a. This application must bo completely filled in by typewriter or in ink ~nd submitted to th~' Build*m~_ t-;?ector, wilt sets of pl~.% ~',',,mte plot plan to scale. ~ =ccorc[ing to schedule. b. Plot plan shmving location of lot and or buildings on premises, relationship to adjoining premiats or pubtic stre: or areas, and giving a dots:fled description of layout of property must be dr=wa on the diagram whi~is par: of cation. e. The work covered by this application may not be commenced before issuance of Building Permit. ~. Upon appron( or' this application, the Ruildin~ Inspector will issued a DuiIdin& Pcrmi£ to the appilc~.nL Such per~. shall bc kept on the premises available for inspection throu~out the work. e. No building sh~ll be occupied ar used in whole ar irt part fora.ny purpose whatever until ~ C.~rtificate shall have been granted by the Building inspector. APPLICATION IS R'ERI=~y MADE to the BuRcting Depm'tm~t far the issuance of a Building P~m....it p=.-x-.~ant to Building Zone Ordinanc~ of the Town of Southold, Suffolk County, New York'. and other applicable Laws. Ordinances Regulations, fat the construction or' buildLngs, ad. ditions or alterations, or for ~emoval or demolition, ca herein desc~be: The applicant agrees to comply with all applicable laws, ordinances, building code, housin= code. ~m~ regu!:tious, and ~dmit =utt~odzed i~spector~ a~ prcmixes and m building for nec::sary ~spections. · i ..... ;tare whether applicant is(~, lessee, agent, a~chitcct, engineer, general contractor, electrician, plumber or builder '."F: ...... : ....... .... .... ~m~ ot,~wner o/premisc~ ~ ~ .... ~ .......................... ~ .............. ) ' (as on thc tax roll or latest deed) applicant Js.~ corpo~tio~.~ture of duly authorized of~cer. (Name and title of corporate of~ccr) Builder"- I ;tense No ..... .Q,~./]/~',-. .......... Plumber's License No ......................... FJcctrician's Liccn=c No ....................... · Other Tfadc's Liccnse No ...................... Location of/and on which proposed work will bc done: Ilousc Number Street. ' ' Hamlet . County Tax M;q~ No. I000 Section .................. ~luc~ ............... Lot ............. ~ ~-.. (Nnme) Slate existing u~ and occupan~ or prcmiscs and. h~tcndcd usc a.d occ,~ancy. ·. of proposed: constr,c~' A. gxtsc~ng use and occupancy ............. ~-.~ ~. 'Intended use · qccuvancy. ;--. · ................................ ? .... ~ ..... 3. Nature. of wink (check which aplMiCa~lc): New Duilding .......... AdditiGn ....... ~Ml~r~ ........ RepOt.. ............ ; 'Rkm~pI .; .... . ....... . .... s~ ~.. ......... ~.~...Oth~r ~or~ ...... 4. ' : ' ' ....... ~-...e:~ ......... 7.'.'..~ ~;.'.'.:: {~c paid on filing this a~plication} ~. ?~.=..~ o,,, ............ ::::::.. .... ,,,~ o, ~,~,,,n~ ,,.,,7 7~ 77°5 ....... ' busm~ss. ~mme~ial De mLYed ~cu~an~, specify nature and extent of each t c of usc ....... utnlenamns of e~a& st~C(urcs, if an · Fr Y ..... .. ............. .. ........ , ............... --' ~,-~ a~mclure with al ,-,; ....... , ... L' ................................ ' ..................... tiei~t ................. Rear ..... .............. · .. Number of Stoics ........ ' ..... ' ..... . ...... 8. Dimensions ofenti~ new construction, Height ..... · Front .......... ;;,~r~ ~: .......... Oumber of ~a~, ...... ,car ............... Depth ....... 10. DateofPur~ ~ ~_ ~_- ...... Re~..~ ~ a~ ~ / ....... ~ ..... -. · :~..~..~.-. ' '. ~ ................. ueplh ...~e.L'.~ .~ ...... ' 11. aunt or use aUtrtct m which ,,r---e-* ' · ·: ....... ~. nnmc of FOyer Owner 12. Does nronn,.a .- - . ~ ~,,.~s ate ~tuated..~L~.k .......... o ......... · ~at~ any Z~m~ law, offitna ....... & ~ .......................... 13. WBI lot be r~de~ . t~., . ,,~u or regulation: .~.. ..................... 14¢ N~e ofOw~tp~~ ~ t .... &et,' ~' 'e'Wdl excess fill bc removed from rmV=: Ye: ... · N~eOfAr~bitect ' ~=~'~dre~.~e~~.p -. ,~,t ..... · e ~ .... ---'~-~I~ ~ ~ --. ~.~-~-.. .......... rnone~,o ............... PLOT DIAG ~M ~a~ C~y ~d ~c~ ~1 ~Ud~, whether' . . P~pe~ ~h=~ ~{~ ~treet ~d block n~bcr or des . .. ~i;ting or proposed, ~d. md:cate ~l set-back d~ec:ioc~ ~:. interior or comer ]oL ' cnpt;on accord~g to deed, ~d ~w 76~-~802 9 AM TO 4 PM FOR THE FOLLOWINrG INSPECTIONS: 1. FOUNDATION TWO REOUIRED FOR POURED CONCRETE 2. ROUGH - F~AMING & PLUMBING 3. INSUI. J~TION 4. FINAL CONSTRUCl'ION MU~T BE COMPLETE FOR C.O. ALL CONSTRUCTION ~IALL MEET Tag. nC-QUI~ 01; ~ N.Y. STATE CONSTRLICrlON & ENERGY COOES. NOT ~ FOR DESIGN OR CON~rRu~IoN ~ STATE OF NEW YORK, :OUNTY OF (Name orindividual ............ · signing contract} bore named. being duly sworn, deposes and says that hc is thc applie::. :C is the .......... . ' (C°ntract°r,,agent, f'°1'porat¢ officer, ertl) ' ' 7 ................. ~' :aid Oxvncr or owners, and is duly authorized to perform or have perforrcl:ed lite said xvork and to maa:e and (lie ti: :)Plicalian: that all statctfients'cont~med 'J41 Ibis aPpficat/on are true to the best of his OrR will be peri'orated in lite manner scl ~orth in the~pplication filed knowledge and belief; and Iltat .yom to before mc this therewith.