The URL can be used to link to this page

Home My WebLink About17290-zTOWN 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~ 017290 Z Permission is I~reby gragted tM /7 // , .-~ // ~-..c ~.,,/...;..~.; ....................................... ..................... ...... at premises located at .,.,,~,,.Z~ ............ .~,~...~..-~-~.~/,~ ..................................... County Tax Map No. I000 Section ...... .~.,.~.. ......... Block ........ .//.. ....... Lot No ........ ..~...~... ....... pursuant to application dated ...... ~ .~... .................................. , lO...~z~,., and approved by the Building Inspector, Rev. 6/30/80 ~T FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTaoLD. N.Y. lm71 ~/8,/.~, TEL.: 7(35-1802 Examined .. . ....... , 19~z5~ '" · ...... , l Pe.n. No./. Disapproved a/¢ ..................................... BOARD OF HEALTH .... SURVEY ... CHECK . . . ............. HA~L ................................. P or)' ' ' APPLICATION' FOR BUILDING PERMIT INSTRUCTIONS ...... ' ...... a. Tl~s ~PpHc~fion must be c~mpl~tely ~]led ~n by ~pew~ter oran ~nk and subm~tte~ to the Bu~l~n~ InspeCtor) sets of plans, aCCurate plot plan to scale. Fee ~ccord~n~ to schedule. ) b, Plot pl~ show~n~ location of lot ~nd of build~s on premises, reladon~Mp to ~d~o~n~n~ premises or pab~c or areas, and -' ' . ca,on, oxvmo a det~led description of layout of property must be drawn on t~e diagram which is pa~ of t~s app , c. The work covered by t~s application may not be Commenced before iSSUance of Bu~d~g Pe~it. fl. Upo~ approval of this aPPIJcation, the Building Inspector w~l issued a DuildMg Pe~it to t~e appEc~t. Such ahall be kept on the Premises avn~able ~or ~spection throu~out the Wor~. e. No build~g shall be occupied or Used in whole or in part for any purpose whatever Until a CeEificate of Occup~c shall have be~n granted by ~e Bulldog Inspector., APPLICATION IS HEREBy MADE to the Build~g Dep~ment ~or the iSSuance of a D~ld[ng Pe~it pu~uant to ~i Building Zone Ordinance of the Town of Sout~oId, Snffol~ County, New YorE, ~d other npplicabJe La~vs, Ord~ces o Regulations, for the Const~ction of bufldM.s addi ' · Th; applicant agrees t ....... ., , %, . tmns or alterations, 9r for removal o[ demohnon as hereM desc~bed admit authorized u comply w[t~ all apphcab~e laws, ordinnnces, building code, housm~ code, and regulations, and tc ~spect~o~ on ?cruises and ~ build~ for necessa~ inspecti~. ~ (Mailing ~ddress of applicon} ..... : ~t~te w~ether applica~.is,6w~er, lessee, ageht,"~hi~ect, ., . ~.~ ,.: . . engineer, ~enernl contractor, electrician, Plumber or builden . . ~e;<-~ ,~ ............. M~ ..................... · · ' ....~.. .... < ....... , :, (as on the tax ~oll or latest deed) · ff applicant is a corpora'lion, sign:tu~; or duly ~dthgrize~ officer. (N rid ...................... amc and e of co.orate officer) Builder's License No.. ~.~ Plumber's License No ..... Electrician's License No ....................... Other Trafle's License Ho :. tocation oca~u o~ wl~ie~ p'~opos~u wo~ xvi/l be done...~~'~ . ~o~/~ ............ tlouse NUmber ...... S ......... ~O~ ]C ' /reet~ ........ ZC ~ , ~ ~ ~.~ Hamlet ............. ............ ~ ...... E~I Map ' ' (Name) .......... cd No. ' ' ' ' State e" ~ ............... Lot.. ~ .. XlStmgt/scandoccup~nc,o[ remiscsa ....... } P nd intended use and occupancy Ofproposed construction: ........... ~,..,~. v~ .~7~:~ ........ b. Intended Use and occupancy .... ~O..~..~v. ~, 0 . '' ' '~ ............ ' 3. Nature et work (check which an,~lica~.,.,. ,., . . Rep~r . ~,. ~'~- ,-,c~. ~',ew Budding . ' .~... ~ ~' ............ ~xcmoval . ~ ........ lx~omon .......... ,Mterati~n ....... 4. Estimate'd Cost .....cscnptton If dwelhng, number of dwelling units . . - tie be pa:d on filing this application) 6. ........ ;. '"' ', .................................... '"' 7. Dimens oas of ex ~* ~, ~ . ~ y ,a~ure ann extent ofeact~ type of use ...... ' .... ~5~ght .''"; .......... ~umber oCSto~es .. ' ............... Depth ..~", ....... ~:mens:ons Oisame structure w th alterations or ad '~n~ ....... Depth ...... i ................. Rear.. · ". ........ , .... .. ....... 8. Dimensions of entire new construction: F ................. Number of Stofies ........ 'gl ............... ,, . ron . . He~ it t ............... Rear ....... De :~um Ocr of Stories ........ pth ..... ........ .............. : ............ 10. Date of Purchase ........ ;... · ...... Depth .............. ip ................. Name of Fo~er Owner '. 11. Zone or use district in which remises are situate ................... ~i :~.' · ·: .... 12. Does proposed Construction elate any Zen n-' " ................................. ' ' ' W~I 1 ......... 13. et be regraded ...... ~ ~ ~, ordinance or regulation: ........ fp .................. ...................... Will excess fill be removed from premises: Yes 14. N~e of Owner o remises ..,. .................. Address ........ . N~e of Architect ........ ~. · .......... Phone No .... ' ................. Address .... · ......... N~e of Contractor ....... [ ...... ' ' ' ' · .......... Phone No ............. ............. Address .......... Phone No ..... 15.Ia this property located wlthln300 feet of a ~idal wetland? ~YES .... NO .... · If yes. Son,hold To~n Trustees Permit may be required · -, PLOT DIAG~M ' Locate cle~ly ~d dist~ctly MI bu~d~gs, whether existing or proposed, ~d, indicate ~I set-ba~k d~ensions fro~ prope~y, ~nes. Give Street ~d bloc:k number or description according to deed, ~d show street ~es and Md{cate whethc: interior or CO. er lot. ' ~P,P~O~VI? AS NOTED _~? BUILDING ,~.§4802 9 AM TO 4 PMFOR THE FOLLOWING INSPECTIONS: '1. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 1, 2. ROUGH. FRAMING & S. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR CO, ALL CONSTR~.Ji~M,[ MEET THE R~ OF THE N.Y. 8'I'ATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS No. 470;'878, Suffolk lem~ ~pires March 30,19 ~,,,,/r (Signature of applicant) STATE OF NEW YORK, COUNTY OF ........... S.S · ' ' ¥ ' ' ........ i .......... being dui3' sworn, deposes (Name o£md~v~dual'si niu, g cOntract and.says ~bove named, r ' that he is the applicant {e is the ' ' (Contract~ at~eut , , Corporate officer ere ) · f said OWner or owners, and is duly imthorized to perfoFm or have performed the said Work anti to make and file this :~plication; that ali statements containled in this application are true to the best of his knowledge and belief; and that the 'Ork w/ii be performed in tile manner sbt forth in il~c application isled therewith. ,Yom to before mc this