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Home My WebLink About19869-z l~OB~f NO. ! 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_~ 198~9 Z Permission is hereby granted to: ....... .... L .~.~ ............................................................. , ~ ................................. '";~' ........................ 7""."". ............. ;'" ........ 7;'"~"-"~ ................................... at premises located at !...~......~..~.. ...... ~//~......~J., ........... .~..~ .................................. Co~n~ Tax ~op No. 1000 Section .J...~. .......... Block ..... ~.~ ........ Lot No..~.-/. ................ pursuant to application doted ....... --.~...~..)..~. .................. 19..~...).., 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.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT BOAgD OF HEALTH 3 SETS OF' PL.~'S .......... SUgVEY ClIECK SEPTIC CALL . o t'IA r L TO: :? Date .................. , 19... ~ ~ , DESIGN OR CONSTRUCTION ERRORS ,ocation of land on wtlich proposed work will be doue.. ! ~ .C'.C3.:~5...~. l.cx L.~..-t{-,~ :,r'. ~.q-~.4.~... ~ 3 ..... 'ouse Number Street Hamlet ounty Tax Map No. 1000 Section ..h.~ .......... Block ..... ~ ........... Lot.. ~.~..~ ........ *bdivision ..................................... Filed Map No (Name) ............... Lot ............... ate existing use and occupancy of premises and intended use and occupancy of proposed constroction: Esisting use and occupancy 5 ~l~ ................................ ,~ [}~27.! ~?~ .. ~.)~: q?: ?~% ~ ........ Intended use and occupancy , ,j~ ..... .,~;0¢gt~ ~ '~ amc and title of corporate officer) Builder's License No .... ~., ,&<,..A:/..~.~.,.. ........... Plumber's License No ......................... Electrician's License No ....................... OtLier Trade's License No ...................... 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. 1. FOUNDATION TWO REQUIRE[') FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR INSTRUCTIONS $. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatinnshlp to adjoining premises or public streets a, reas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi- ion. c. 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 i1 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 11 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 lding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;ulations, for the construction of bu;idings, additions or alterations, or for removal or demolition, as herein described. : applicant agrees, to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to fit authorized inspectors on premises and in building for necessaSy~nspections. ..... \ ................. (Signature of applicant, or name, if a corporation) ? (Mailing address of applicant) te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ~*i .................................."" APPROV.[O AS.~OT.E.D .... ne or owner of premises .... · .~.%r'. ~...'XJ .g.c. 1-~ ....................... DATI~; ~ .B.?..# :~ (as on the ta;~, roll or latest dee~E: ~ S. -- . BY: :-~ .... 2plicant Js a corporation, signature of duly authorized officer. ,' · NOTIFY BUILDING DEPAFtTMENT AT 3. Nature of work (check which appllicable: .......... Addition Repair , ) New Building ..... .......... ,\Iteration .......... ......... Remo al .............. Demolition Other Work. 4. Estimated Cost .~.c~.c~. j (Description) 5. If dwelling, number of dwelling u~its .... ~ ,, . (to be paid on filing this application) · If garage, number of cars ., ! .......... :~umoer of dwelling urdts on each floor 6. Ifbusiness, comnercialo.'_':,,''.'i ....................................... '. ' i ............ .... , . . --,,,.ca 9ccupancy spec' ature and ex, tent ofcach type of use .... ~'-,-"... /. ~nnens,ons ox ex~stmg structures,!ifany: Front. }'.~..:~i-. ...... , · · F, ear ........... '... DepthS... ] .......... Heigb. t . .:~, ........... Num ~¢r of Stories .................................................. Dimensiohs of same structure with alterations or additi · , Depth ......... Hell i- OhS. F ............. rent Rear 8. Dimensions of entire new construdtion: Front ... · · · · .. r~t mcr el atones ........... . .... · ... u ~ '" ........ ' ....Rear .... Height ....... N mbeir of Stories ... ~'..., i'q ........... Depth ............... 9. Size of lot: Front ...... ' ............. ,. 0. Date of Purchase . ' ...... I ......... Rear .... ' ............................... ..... ' ............... Depth' · ....... ......... Name of Fornler Owner . I. Zone or use district in which premises are situated ....... ' ........................... Does proposed construction violab any zoning law, ordinance or regulation: Will lot be re-rad~ , - ~ ' ......... [ ................. :,Vlll _e~ce~ss till be removed from premises: Yes No 4. mameofUwnerofpremises.lT~c~3~,_.c.~..e- ........ Address~-~'.3.c3~.q~ m ~, ~,.,e, Name of Architect ........... . . ... ^.t,i, I-q:..,,dih- ~,5~h' .....r~lone ~,~o. LI .~.~%..-...5.~Ae ~ .... ........ · ,:,~,ess · ~ ," Pt Name of Contractor ........... · ............ tone :~o ................ ............. Address ................... Phone No ................ 5. Is thi~i~roperty within 300 feet of a tidal wetland? *Yes ........ No ...... yes, Southold Tow Trustees Permit may be required. ''' .... PLOT DIAGRAM ~ Locat.e. clearl,y and distinctly all buildings, whether ~--' ~' - --~-- , ~ ' roperty brits. G~ve street and block number or desc~:~,:-;, ~ ~?_s~ed,_ and:ih.~cate all set back dimensions from iterior or corner lot. ~mg re Cleed, and sllow Res and indicate whether ,TE OF NEW ¥OEX.' 'JNT¥ OF. S.S (Name of indi9 du I signjn~'cpl~tract) p an says tha~le · the applicant 'e named· the ' '~ ~orporate officer i (Contractor .................................... ' , etc.) ~id Owner or owners, and ~s duly atl or/zed to perform or bare performed the sam work and to make and ~le this cation; that all statements contained iff this application are true to the best of bis knowledge and belief; and that the will be perfomed in the mawr set forth i ~ t e a ~lica ' ,~ to before me this /-'~ ! PI ten filed therewith. t~'~'~ 31,1~ . (Signam~ of applicant)