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Home My WebLink About19193-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, H. Y. No_ BUILDING PERJ~flT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ 1 9.~ Z Dote .... .'Z..'Z**~.. ........................................ , ~.~ / County Tax Mop No. I000 Section ......... ~....,,~....... Block .........~ ........ Lot No .......... .././.. ......... pursuant to application dated ....... ..~..~..~,. .................................. , 10..~."~, and approved by the / Building Inspector. Fee $. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTItOLD. N.Y. 11971 ~ .~ .~.~./.~, TEL.: 765.1802 Examined ............ 19 ,~.~. Approved..'~z .. Z~. ......... 19 ~'~, Permit ...... ~ Disapproved afc ............ (Bla~ldi J~pe~tor) ' ' ng APPLICATION FOR I~UILDING PERMIT INSTRUCTIONS BO'tRD OF HE'~LTH ~ 3 SETS OF PL,AN.~_..~.%...-. SURVEY ' * .... SEPTIC FORH .... MAI~ TO~ ~ ~o ~" ' ] .... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Build~' [~'Pector, with 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 premiu~ or public streets Or areas, and 0' ' .- olvm~ a detailed description of layout of property must be drawn on thc diagram whichi*pa~ of ti.is ;- cation. . c. The work Covered by this application may not be commenced before issuance of. Building Permit. - applil d. Upon approval of this application, the Building Inspector will issued a Building Pcrmit to the applkanL Such'permit shall be kept on thc premises available for inspection throuehout the work. e. No building shail be occupied or used in whole or ~n part for agy purpose whatever until a Cc~tifi~ of Occup~mcy shall have been granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Building Department for the issuance of a uilding Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo'rk, and other applicable La~, Ordinances or Regulations, for the construction of buildings, additions or alt~ations, o~' for femoral or demolition, az hexein described~ Tile applicant agrees to comply with all pphcable laws. ordin:fnces, building code, housing code, and regt~fions, and to admit authorized inspectom on premises and in building for necessary inspections. . ~[. ign~t~re'o'f~pplica or name. ~la corporal;mn) ~ .................... '~" (M iii dd f pplicaht) a nga resso a : ' leg~i~[/'~is.q~vne~'Idessee, agent, architect, engineer, general contractor, electrician, plumber or builder. D<:,~MU Fi ,,ii : ~', >' ' (as on thc tax roll or latest deed) .............. If applicant is a " ......... .'~a ,-,:, ,:, eorpora,tion, signature of duly authorized officer. title o~'~orporate officer) ' · License No ' Electrician's License No ....................... Olher Trad¢'s License No ' · Location of land on which proposed work will be done; ouse Num her Stre Hamlet C tyTa M pS ' 1000S ~. ...... Eilcd Map No. · :;' (N ) .. Lot State e-' ' Xatmg use and occupancy of premises aod intended use and occupancy of proposed construction: · ~ 3. Nature of~ ork (check which app!icable): New Building .......... Additic, n .......... /'dtcratmn ........... R_epa~r .............. E~mov~l .............. Demolition ............. Swi=n. ing pool ............ 4. ;' timated Cost ........ ...................... Fee ......... ............ ; ..... " i ' (to be paid on filing thisapplication) 5. ifdlit,, nulnberof uWtS" ' wc...n=, dwelling .......... : .... Number of dwelling units on each floor ............... ~f-ara" numberofcars ' · 6. [f business, c . . I ....... ~ ..... ommercml or mixed 9cCUpancy, specify nature and extent of each type of uso ................ 7 Dimensions of cx~sting structures l if any: Front Rcar Depth Hcie 1~ Nm ~ber of Stories D~mens~ns of same sti'betbre wtth alterat:ons or additions: Front ..... Rear ~,e~,m ......... ~-. i Height Nu ubcr of Stodes 8. m~nsio~,.,~df entir~_~w coh~t~m~tion: Front ......... Hmsht .. .,~. ...Numb~rofStories ...... . . . &. ~, · . ~ ..i .......... lq, ca ..................... Deptll ~ ,~ .:. - ,'~. ~ ~'-~-~t,: · ·., ................. ~ame o~ ~'omer uwner ............... ...... i 1. ~one or use dmtriet in Whi~]v-~: ...... D ~.~.~ are muatea ............................... ~..~ ....... 12. ocs proposed construction viola e an~ zoning law, ordinance or regulation: 13. 5V~l lot be regraded .; ....... 1 ................. Will exces~ fill be removed from pr~mise~: ~e~ .... No. 14. N~e of Owner of premise~ ~. ~ ~.~.~.. Addres~ ~.~O~.Q .~t~., .¢~. Phone No ................ Nme of Architect Addres~ Phone ~e o~ ~ontractor .......... ~ ................ Address ................. Phone No 15.~s this property locat~ed within I00 feet of ~' tidal ~etland? ~YE5 .... NO.~ ~ll~ yes~ Southold To~n Tru=tees Permit may be required. ~~y'~ ~d distinctly' ~l bu~d~gs,' ' whether existing or proposed, ~d. indicate ~I set-ba~k d~ensions from prop~ ~nes. ~ive street ~d block nhmber or deschption accord~g to deed, ~d show ~treet nme~ and ~dicate whether STATE OF NEW YORK, COUNTY OF ................. I APPJH)VED AS NOTB) 76B. 1802 9 AM TO 4 PI~ FOR THE OLLOWING INSPECTIoN~i ~OR POO~Er) CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS .... ly ppli ......................... ................... being dtl sworn, deposes and says that he is the a cant · ; (Name of individual signin ;contract) abov~ nam'ed. gte isithe . , ,' (Contractor, silent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this Ppb~atmn: lhat all state~nents contan :d in this application are tree to the best ofhis knowledge and belief;and that the worl~iwill be performed in the manner get forth in thc application qlcd therewith Swot9 to before mc this · . , I .... : ......... l.~. ........ dayof '. .......... , 19 h'ota~ Public, ..~..~. ,~,-."~-..r.- ......... County ' ''- NOTWtYrUeL~, 'i~ Y~k ,, · .................... _ No. 4707878, ~fl0 k (~atY,o;" (Si="nature of applic~"tt) Term ;.~res ~feh 3 l, l~..-.~' ,~ '