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Home My WebLink About19810-z ~voum' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8 10 Z Dot, . ~... ............... , .. Permission is hereby gran~_.~ (~~ · ~..~.~.~..m..:.~..~...~ ................~ ~ .~.,~ ~.~...~ ......... ~.~ ...... ....~..........~..~..,~ ............................................................... CounW Tax Map No. I000 Secti~'"~...~...t....~.. ...... Block ...... .~..~ ..... Lot No ..... .'.~......) ........... to application dated ..~ ....... ...-~'......2=7... ............ , 19.~..t., and approved by the pursuant U Building Inspector. Fee $..P...~.~ . Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 ., 19'tl. Permit No. Disapproved a/c .... . ........................... "''"D APPLICATION FOR BUILDING PERMIT BOARD OF liEALTtl ......... 3 SETS OF PL,~S .......... ';;il,": ............ SEPTIC .......... CALL ................... HAIL TO: Oate ......... 19.9t INSTRUCTIONS h. 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. e. The work covered by this application may not be c~)mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 coristruetion of buildings, additions or alterations, or for removal or demolition, as herein described. :'he applicant agrees to comply with all applicable la~vs, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspe~gions. ~/P~ ~+~-q~'t~/ '. 1,__ (Siamlture olapplicaot_2orn~,me, ifa corporation) tare whether applicant ~luw,~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame of owner of premises .......................................................................... (as on the t,.'~t' roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... '' ' ' No Electncmn s License ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................ , ................................. House Number t ~" Hamlet County Tax Map No, 1000 Section .... 1.~ .......... Block ...~. ........... Lot .... l .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of prem?es and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ 2V¢1 r,, UI~,~.~ .......... Intended use an ' b. d occupancy ................................... ~r~l~.,:;i .'..,;,,,;~i ~ · *ik ~.~ ........ property lines. Give street and block nulmber interior or coruer lot. 3. Nature of work (check which applicable): New Building ....... L.. Addition .......... Alteration 4. Estimated Cost . .. . ~. ~ (to be paid on fihng this applicat on) 5. If dwelling, number of dwelling u ars ............... Number of dwelling units on each floor ...... ..... · If garage number of cars ............... · .... ~ '.e .mm.~-.c' ' do "~ ............................... 6. bus]n ss, co e mi or m~xe CCupancy, specify nature and e tent of each type of use ., ' ' ..... 7. ~,imens~ons et exmt~ng structures !if any. Front 4 ,~.. ' ,-.; ' ', ...... ~ ' ........ bl ,x,a, .............. Depth ............... Height ............... Num er of Stories ................ ; ........................................ Dimensions :fyame structure with alterations or additions: Front [ .............. Rear .................. Depth · · i Height ................. I. · · Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... ~ear ............... Depth Height ............... Number of Stories ........... · · · I ............... ........... ~ ........... Depth ...................... 10. Date of Purchase ............ : ............. Name of Fenner Owner ............................. 11. Zone or use district in which premises are situated 12. pose tructmn vmlat? any zoning law ordinance or r gulation' -. ' ..... wm ~o~ ee regraaea i ' ' ' ' ........................ 13. · .................... Will excess fill be removed from premises: Yes No i4. Name of Owner of premises .... i ............... Address ...i ................ Phone No ................ Name of Architect ........... i ............... Address ... i ................ Phone No ................ Name of Contractor .......... t0 ............... Address .. 'i . Phone No ...... Is this property within 30 feet of a tidal wetland.l *Yes ........ No ......... · If yes, Southold To~n Trustees Permit may beirequired. "'. i PLOT DIAGRAM l Locate clearly and distinctly all buildings, whether existing or pr~)posed, and. indicate all set-back dimensions from or descriptioh according tc deed, and show street names and indicate whether APPROVED AS NOTED FEE. ~ aY. 2. ROUGH - FRAMING & PLUMBING 3. INSU~TION 4J FINAL CONSTRUCTION MUST ~E COMPLETE FOR *~ CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NF~U,C~OR.kl?,. [3 rL · ....~. ~ t~ .... . .(~...f.F'..t~.P~. ~.~.I ................ being dul? sworn, deposes and says that he is the applicant (Name of indivirlual signing ¢ontract) )eve named. (COntractor, agent, corporat~ officer, etc.) md Owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file h 'plication; that al/ statements containe~ in this application are true ' ' t is to ~he best offns knowledge and belief; and that the ork will be performed in the manner seti forth in the application filed theyewith. peru to before me this ) a ubl n Not~ Pubt o. State of 8,wYoek ...... d . NO. ~870606 I /7. ~' ' ' - .Qualified I.n S[ffolk .C~m,J..c/'7/ of applicant)