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Home My WebLink About19061-zFOUNDATION (1st) FOUNDATION ( 2nd ) .ROUGH FRAME & ~?LUMBING 3. INSULATION FERN. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOi. D, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISF_.S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-o '~ 9061 Z Dote / Permission is hereby gronted to: ..~o~..=**.~.~......~.~....**~.***..** ............................ ~ ,.p. . II~.~-- ' CI~ · ". i"_' ';"~a o ... ~, ..... ~..~****. County Tax Map No. I000 Section ......... ).!...~ ........ Block ..... (J~.~.'~... ..... Lot No....~.~..'..~ ........ pursuant to application doted .... .,,.¥_~****~..~,.J..~ ...................... Building Inspector. and approved by the Bu--)Iding Inspector Rev. 6/30/80 FORM NO· t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTItOLD, N.Y. 11971 TEL·: 765.1802. Appro,'ed ..... '~\.., l~ fl.0. Pe~it No. J~%~...~. Disapproved afc (Building inspector) APPLICATION FOR BUILDING PEHMIT BOARD OF HEALTH SURVEY .. SEPTIC FORH ................ NOTIFY~ NAIL TO: INSTRUCTIONS ,a. 'Tltis application must be completely filled in by typewriter or in ink and submitted to the Building I~pec'tor, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pt:m showing location of lot and of buildings,on premises, relationship to adjoining premises or pubLic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which i~ part of tkis appli- cation· c. The work covered by tMs application may not be commenced before issuance o[Building Permit. · " ' d. Upon approval of this application, the Building Inspector will issued a Building Permit to thc applicant. Such permit shall be kept on the premises available for inspection throug.hout the work. e. No building shall be occupied or used in whole or in part for a.ny purpose whatever until a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law,a, Ordknances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. aTdll¢ .applican.t agr. ees to comply with all applicable laws, ordinances, building code housin- · m,tauth_o~ze, msp~tors~on pre~,ses an? ~ bui,d~g for neee~_%i.C, ct~o.~ ~_'" t~code..a.%~/a,,o=, and to (Mailing address of applicant} State whe'ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build/~r. 0 e (as on the tax roll or latest deed) 1£ applicant is a corporation, signature of duly authorized officer. Builder s License No ............... Plumber's License No ......................... ( ~L/ (z~g{'.{ ~tOf &O~~ Elcctrician's, Hccnse No ....................... Other ~ra~c s .censc ~o ...................... ) .. I. Location of land on which proposed work will be done; · N bet ' St oust um rect Ha~ ' ' nlet Co nty T M p N 1000 S rio ' ' u ax a o. oc n ................ Block ..... ~ ............. Lot .... u v s on ........................... ~ ...... Riled Map No. (N ) .......... Lot ..... . .... i · ' ,o::.,:.:~ .............. 6 .......... Z~..p... a~a (~a~,.,} - ~ ,-. - ~..4:,.~ ~ .... : / ~ , ........ ¢ ......... ,. .............. ~.,ntenOed USe an= I-I~b rlA kuuvFI / IAh~fla~¢t < a'~ ~. X '' uoccupancy .............. ~ .... : .... d...~, r;~a~ ~lv~ACl 3. Nature of',;ork (cheek v..hich appiica~le): New Building .......... Addition ......... /dtcratzo.. ~ ....... Repair .............. R~mov:al ............. Demolition ........ S w L,'lqll~£.l~p ~ o'1 ~ .......... Tennis Court ...... A~cessor--" ''J' '" .... m,~u~, ~' ' ~ · ~- , Y ~uzzozn§ .......... Fence ....... Other (qork ............ 6oO oo ... : (to be paid on fiIing this application) 5. If dwelling, number of dwelling uhits ..... .~.~.~. ·; .... Nnmber of dwelling units on each floor ...... ~ ....... I~ garage number of cars ...... ....................... ~ ...... ~ ......................... 6. If business, commercial or mixed ~ccuoancy, specify nature3gd extent of e~h Wp~ Of usc ...~U~[~..C~60~2~ 7. Dimensions ofe~sisting stmctures~ ifany Front ..... ~.'. ~ ;. Rear ...~..~.' Denth ..¢Q .~..... ~mensmns of ~ame ~tmcture wire alterations or a~ions: Front ..... ~.. ~: ..... Rear .... ~..~ ~...'... Height .... ~q ....... NunLber of Stores ............ ~ ...................... 3 ......... ~.. Do s proposed Constructmn wolate any zoning law, ordinance or regulation: .... 9.~ ........................ 13. ~VHI lot be regraded .; .... , ..D.q .................... ~Vill excess ~ll~e,r~.oved flo~,~remises: . Yes... 14. N~e of Owner of premisesln r } .... [~'~3~ne No ~3~-6~fl N~e of Contractor ....... ~b:~ .~9~ ........ Address ................... Phone No ..... ;,' ......: ..... 15.Is this property located vith~n I 00 feet of a tidal wegland~ ~YR$.~..~O ~IE yes~ Southo[d TowniTruntees Permit may he required. PLOT DIAG~M Locate cle~ly ~d dist~ctly ~1 bu~d~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block gumber or description accord~g to deed, md show street nines and ~dicate whether inte~or or comer lot. : STATE OF NE~V/~O~, ,~ - S cOUnTY OF (Name of individual stgni'~g contract) above nam'cd. H~i~ the ... ,' ' , , . ntractor, agent, corporate officer, etc.) of ~aid owner or owners, ~d is dul~ authorized to pe,rform or have perfo~ed the said work and to m~e and file this application: that all statements contained in this application are true to the best of his knowledge and belief; and that the work w~l be perlbm~ed in the m~ner set fortl~ in the application filed therewith. Sworn to before me this ,~'," .......... ............... day of;. Nota~ Public, . ' .... County , d0, 409~735 , Ouali~od tn Su~loA ~u.~ _' ~ ~ ~ (Signature of applic~t)