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Home My WebLink About19106-zTOWN OF $OU~OLD 8UILDING D J~PARTA~I~NT TOWN HAtL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N-° ~O,d Z Permission is hereby granted to:. , /] ~ ..~ ~ ~..~ ~....~...~..~ ................................ , ..... ~ ............. ~..Z~.~~ ~, ,,,~,~e, ,~,,~ ,, ...~z~....~.~.~ ............................................................ ......................................... ....................................................................... co.~w ~, ~ ~o. ~o0o s~,io. .......... .~. .... ~k .......... .~ ....... Lo, ~o ........ ~.~ ...... pu~uant to application dat~ ...... ~ ............................... , 19.~., and approv~ by t~e Building Inspector. ....... Rev. 6/30/80 TOWN OF SOUTHOLE' Examined .......... 19,. ......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTItOLD, N.Y. 11971 Oisapp r°ve~j~P, OVED. A$ I~.TED ......................... · ~,..~ . .-, .'.'.. ~?. FEE: NOTIFY 8UI£1~ING 1. FOUNDATION - ~OREQUIRE~PPLICATION FOR BUILDING PERMIT FOR POURED CONCR~E 2. ROUGH * FRAMING & PLUMBING 3. INSULATION BOARD OF' HEALTIt ............ 3 SETS OF PLAt'IS ............ SURVEY . SEPTIC FORH '. ............... NOTIFY: CALL . ..... Date ..' ...... I~... ; 4. FINAL CONSTRUCTION MUST INSTRUCTIONS MRLETE FOR C O ~S ~.~aR~,A~umt~_~l~ .~.. ~,. ~ .... 1~ ink aha suumittcd to thc uuilding ' rotor with He~ ~R '~- ~, ~E~ y rue uCCorain~ to sched °ra~ ~'~c~'~"~and °fbuild~s °n prcmisez, rcI3tionship to ad'oininS rc ' · ca.~{~, g~g ~O8~{Id6~ripO~n of layout or property must us ~ ....... ~ o p..~,~ or public streets -~E~;N ~,~fi$~RORS - ~ ~u,vn on me magram,wn:~ ~ pa~ of tMs appU- ~ ne Work cOVered bffffMs a~pllcation may not be commenced b ' d'D~~fii~matiofiT' ' ' , . . efo[e issuance of BuUdmg PemlL - . . . the Bu:Idm, Inspector will lSsuea a Building Pe~it to the appfi~L Such pe~it shall h '~'~v ~ea in whole or in part for any purpose whatever untd ' ~-q~g~ ~ ~ufl~gl~pector. . ' a Ce~fi~ of Oceup=cy i~;~?~~c~,~h~mgs, a~ditions or alterations, or for ~cm v PP .. h,. ~rd==c~s or .... ~ ~n~ to COmply wtth nil npplicnble laws ~-d; ........... . o nl o~ dcmoimon, ~ hcr~m described. 4. F~NAL - ~O~w.~ ~,, uum= zor ncccssn~ inspections ' . BE CO~,PLETE FOR C,O. ~'/ '"~ ~ - ~ ' STATE CONSTR~CTiON & ENERGY ~/~ .. DESIGN OR CONSTRUCTION ERRORS (~ailin~ uddrcss oF appiic~t) Sta~e mvhcthcr applicant is owner, lessee, a~cnt, ~chi~c'cz,'ensinuer, Senegal contractor, electrician, plumber o~ builder. (as on thc l~x ~o11 or ia~est deed) ' ' ' ' ' {F~pplicun~ Js u co~orafion, signature oFduly authorized oFQcer. Plumber's License No ......................... E{cctHchn's ~ccnse No ....................... OUmr ~rad. c3 Uccn~c No ...................... Location oFland on Which proposed work will bc done; ousu Number z Street ' Ha ......... Subdivision .............. Lot ....... .................... '- Eil M pN "." ............. cd a O. (Name) .............. Lot ............ ' State existing use and occupancy of premises and intended use attd occupancy of proposed constrnctiom - a. Ex/sting use and occupancy .. ~ ~ ' b. Intended d occupancy .... ... ,~ .... , ' . 3. Nature o£work (check which app;licable): New Buildln§ .......... Add//ion.. ....... . i'dicrat:on ........... Re.ar ....... R mo a, .............. Demo.tion . ."; ....... & ' ~ ..... Other [4ork ............ 4 Estimated Cost Fee ;i (to be pn~d on fiJ~ng this ~ppJ~Caz~on) hi ' 5. ~f dwelling, ~umber of dwelling u ts .......... ~ .... Number a~ dwcllln~ units on c~ch floor ......... ]~g~r=~c, number ofc=r~ ...... ~ ........................ . . 6. If business, commercial er mixcd ~occupancy, spccify nature and extcnt o ~ c=ch type oE usc ....... .............. ............... ........ D pth .................... ~. Het~t .................... 8. Dimensions of entire new consta ~tion: Front Rear Dgpth Hm~ht Number of Sio~cs .~ ........................ · ... ........................ 5 · 9. Size oflot: Front I ~ ~ It . ........... ~ .......... Rear ................ ~'.~ Depth: 10. Date of Purchase ~ .............. _ . , · ............................ Name of Foyer Owner ............................. 11. ~onc or use d~stnct in which Premises arc situated .... ; ................. 12. Does proposed Construction violate any zonin~ law, ordinance or regulation. ~ . . ~.: ..... ~ ...... .. 13. W~llotberegraded ~.. i · ' ' . ...... · ...... ~, ' ' l '~ .i ~ .... ~... ff .....,.~. Wdl cxcessflll he !cmoved from premises: Yes 14. ~ of Owner of premises .~/?~. ~: ~P/~.~Address 1lTq~ffff~ .ff~ ~q~le~hone No. ~.7.~ .~...~. N~c of Architect ........... i ................ Address ............ ~. ~...,. Phone No ..... L' .... . .... 15.ls chis property located within lO0 feet of a .tidal wetland? ~Y~S .... NO~,. ' ~ yes, SouthoId ~owu ~unCees Permit may he ~equlred. PLOT DIAG~M Locate cle~ly ~d distMctly ~I ~ufldMgs, whether existing or proposed, ~d. indicate ~1 set-back d~nsions from property lines. Give street ~d block r umber or description accord~g to deed, ~d show street and h~iut~ whether in[e~ior or corner lot. ,¢ STATE OF NEW YORK, COUNTY OF ................. $.S ........ .' '('~a',~; of individual signiz{g contract) above named. being duly sworn, deposes and says that he is thc applicant (Contractor agent corporate officcr crc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application: that a I statements contai!md in this application are true to the best of his knowledge and belief;and that the Work will be perforated in tile manner :;ct forth in tile application filed thcrewifi~. .,, Sworn to before me this '~ R~ PUBLIC, ~e ~ N~ ~ · . ~. 4707878, S~lk~nW~_ J~m ~t~ Ma~h 30, la ] 7/ (Signature of applic~t)