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Home My WebLink About17413-zTO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 0~74~3 Z Permission is hereby granted to: ............. ~:....~....~.........~.z .................................... · ~__~' ............. ...Z2..:..~....~...~....r' ........ ..~;.~ ,, . at premises located at .....~.. ~ ~ ~ ~ ~.~,.x .... County Tax Mop No. 1000 Section /~/"-~ Block ~ Lot No.....~.....~?. ............ pursuant to application dated ........... .~..../~ .......................... 19.0~, and approved by the Building Inspector. Fee $..~..~ Rev. 6/30/80 APPROVED AS NOTED · 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ' TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3... INSULATION 4, F~NAL - ~O'R'STRUCTIG;,; ~,'I~St: BE cOMPLETE FOR C.O. AL[. cONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE cONSTRUCTION & ENERGY cODES. NOT RESPONSIBLE FOR DESIGN OR coNSTRUCTION ERRORS Examined ..~.C ?..~. ........ , 19 .~.8 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ........ CALL .~ . . ? .. ,~ .... MAIL TO: Approved . .~ ......... 19 Permit No.~../. Disapproved a/c ..................................... ....ii i' '' ' APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Th/s application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 . 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 premises or public streets or areas, and giving a detailed description of 1.~yout of property must be drawn on the diagram which is part of th/s appli- cation. c. The work covered by tkis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall 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 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 Laws, Ordinances or Regulations, for the construction of buildings, a..d. ditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary int~ctions. ~.~ · ..,'(~~~t, ~r I~a~ e',~'a corpo'r.~ r](~n') ' ' ' . .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .Q~..ff...~. ............................................................................ Name of owner of premises . .~\~'."~..-/..~U.P..~']..g...,. J..~.O..{p.~. ................................. fas on th ax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, (Name and title of corporate officer) Budder s Lmense No ........................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ' .... ./.4..6.o. ............... 3. ?./...,¢~..6-7. ..................... .~.0. 77.<.7. ~. c/.< ............ House Number Street Hamlet - County Tax Map No. I000 Section .... /../'~...~. ........ Block .. ~ Lot .~. IQ. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupaucy of proposed constrnction: b, Intended u~e and occupancy .... ,~.r~.~7~,~.~. ................ :. ":~ c<~,~,~)?,~ 7:, {% !,'~L~q F? .................. 3. Natureofwork(check~vlich:applicable).NewBu d-* ' R~,--;- i ' .-o · ................................ etlon ..~i~l... ,-v ................ Removal .............. Demolition .............. 4, Estimate'd Cost .~. / ~.O j- ,- ., " ~[n) ......................... ~'ee ........... i'" 5. If dwelhng, number of dwelliqg units ...... /. ........ Number of dwelling unitsl;~ If garage, number of cars ... If. business, commercml or mixed occupancy, specify nature and extent of eachtvne of use ' ' 7. Dm~ensions of,existiff~ stmctu'res if any' Front . /~../ ' ~, ~q"/4 ti '~,' ' ',' ' b: ;'V' ~ 'o .... ~,. . , Il t ,, , · · , · .~ ,, ...... ~xua, .... I...t ...... ueptn .~?. . ./. ..... · ~ctgtlt ...t~ ........... r~qmbcrofStories t ' · · .mensmns ~f .sa/nt~ ~ttmctt, re With alterations or additions: Front ,/~ t .... Rear ...~. ~ 4/ /} ........ Depth .... ~l ~ ..... Ileght ~! t '"~; '-' ';;,." t "~ ........... .......................... ~umoer o~ btones .... : ........... 8. Dimensions of entire new constmctmn: Front ............... Rear ............... Depth ............... Height ...............Nu:m be,~ of Stories .......... 9. Sizeoflot:Front 114. . .. ;- ' ................................... pepth 9a-.'..2.'. .... D .... ' ' ;~z,~,';:. · · i ' _:_ .... l~ear . ,:~ .~,,.u .............. . 10. oa;Oo~rr~;c~i;st;i .:.Z-.,.../~,..?.~'.e.j.c/f]..~. ...... ~,,NameofFormerOwner :~.~...7.'qq.,Q..~::X...~'O~:)::" 11. Z ct in wmcn Premises are situated .~.~¢ l:?.~.rg. '7~9 Does proposed construction violate any zoning law ordinance or re ulation' ,'Y.Q ....... . 13. Will lot be regraded 2'~/.~. ..... g .... ' ' , ................. .... ~, ................. Will excess I111 oe removed xrom premises: Yes No ....... : .................. Address ................... Phone No .......... ' ' Name of Contractor ........ .................. Address ....... ]5.Is this property located vithin 300 feet of h '~i~/~l ....... PhoneNo ......... ,~.i.':. , wetland? ~YgS .... NO . · If yes, gouthold Town Trustees Permit may be required. ... ! PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot.. STATE OF NEW/~ORIIi?f" / t , COUfl~TY OF. ~. a.~.~., ff..~., iS'S . '(~a,~ of}~fi~}fi~'~}'e~;;/o~{ ....... being duly sworn, deposes and says that he is the applicant above named. ~ ~ ~ ........ ~ $He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to m~e ~nd file this application; filet all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~ne~ set forth in the application filed therewith. Sworn to before me this .............. .... .. ......... OuM~ in 8~ou~..~ (} (Si~aI~e of applic~t) ~mmlss~n Expires D~m~er ~. ~ ~