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Home My WebLink About20232-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) 20232 Z · . . . //~'?/_ .~~..~..~ ................... ~ .......... · .~,~..........~...~..~.~.~.....~,., ~~ .......... :....~..~ .................................................. at premises ocated at ........................... .~......~./..~.,~;.....~.., ......,~-'~ .................................................... County Tex Mop No. 1000 Section ........ ~...~.. ...... Block ...... ...~.... ........ Lot No ........~J...~... pursuont to epplicetion doted ..... ~ .........../.. ............................... , 19- , end approved by the Building Inspector. Fee $..~.....~.~.....~... Rev. 6/30/80 i~ ~ ~': TOWN HALL : ~ SOUTHOLD, N.Y. 11971 , 0CT'2 I !!:;Q,, .~l TEL.: 765-1802 :i, /~./~.., ~/'. 2 E×aniln~¢d ...... 19 D' pp o eda/~ ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT BOARD OF HEALTIt ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ...... HAIL TO: ......... · ..... ..... ' 71~5-I802 9 AM ~ 4 PM FOR TH~PPLICATION FOR~UILDING PERMIT NSPcCTIONS: Date ...... ~/ ., 19... ~. FOHNDATION tWO REQUIRED .... FOR POURED CONCRETE 2 RGUGH ~ FRAMING & PLUMBING INSTRUCTIONS a4 ~gppJic~~. ~{~Ily filled in by Wpewfiter or in ink and submitted to the Build~g Inspector, with 3 ;ets of ~~ ~ ~ to scaI~' Fee according to schedule: b&t pl~g~ l~n ~ and of build,ds on premises, relationship to adjoining premises or pubic streets >r area~ a~$~~ ~i~9.n of layout of property must be drawn on the diagram which is pa~ of this appfi- :ano~ATE CDNS!RUCTIQN ~&-~NERGY CO'~6.~D~°~b~[Bp~Jon may not be c~mme.ced before Jssu~ce of Building Permit. ~e~~aO~B~, the Building Inspector wi]] issued ~ ~uiJd~ Pe~R to t~c appUc~nt. Such ,h~l be kept on the p~emises avaUable [or inspection throughout the work. e. No buH~in~ ~ha]] be o~upied o~ used Jn whole or in p~t fo~ any purpose whatever until a Ce~ific~te of Occup~cy ,h3H have b~en g~anted by the ~uildi~ J~spector. APPliCaTION IS HgAg~ ~ApEto thc Bulldog Dep~ment for the issuance of a ~uHding Pc~it pu~u~nt to the Juddm~ Zone Q~d]~e, o,f t~own of SouthoM, Suffolk County New York, ~d other app~cab]e ~ws O~dm~ces o~ ~egu~tJ~'~ ~:'~ ~:c~J~g ~[.~d~gs additions or a~te~adons or for ~emova] or demohtJon as he~e~ described. Fire 3pp1LC=~t~s to comply w]tA a~ =pphcab[e laws, ordinances, buQdmg code, housing code, and regu]=ttons, and to ~'~[ L- CONSTRUCTION SH~LL MEET (Signature of applicant, or name, if a corporation) CCD~S. NOT RESPONSIBLE FOR ~ (Mailing address of applicant) DEglGN OR CONSTRUCTION ERRORS ~O~I~, ~ ~%9 D( State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... ~.e:C. ..................... : ........................ Nameofownerofpremises ... ; ~..%. ;. ............. If applicant is a corporation, signature of duly authorized o;fiCer_ the(ason t~ roll or latest deed)/~,~ Plu nber s License No ........ ; ................ ~ ~o ~ ~ Other Trade's License No ...................... Location of land on which proposed work will be done.. ................................................ .. .. ................. ........................ llouse Number Street County Tax Map No. 1000 Section . . .O,(D.l ......... Block .... . .Z.~.. Lot .~..?.,, .~., . Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b . ,0~.~.,. ,~, ........... ~ .~,O.[ .[~, .~.,..q~,~.O~.. · · .1~. ·, ........ use and occupancy ......................................... l ,~,~¢~M~. ......... b. Intended 3. Nature of ~vork (check which applicable): New Building .......... ..Additi°n~.~,~A ...... ' .... Alteration .......... Repair .............. Removal .............. Demolition . ,~g...C~..(-~..~.~Other Work ............ / (Description) 4. Estimated Cost..i Fee id on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · If garage, number of cars ......... .c~..C ~(-. ~:q O~5~:~. ·~. ......................................... 6.If business, commercial or mixed occupancy, specil'y nature and extent o[ each type of use ..................... 7.Dimensions o,' existing st uctures, i, any: Front ...... .............. Depth ............... Height ............... Number of Stories ........................................................ ~ ~ ~ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ................ hltLm bet of Stories ............... ¢ ................................. 9. Size of lot: Front ...... . ."~. i..~.~. ?: 2~.. Rear.. i~. ~06,0.~. Depth. :~(~../. a 10, Date of Purchase . . . ./..7~ ...................... N me of Former Owner ............................. I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................................. 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone N..~... ....... ' ....... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No....~%. .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions fr~m property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ~ (,~(o - O ~ TATE OF NEW.YORK OUNTY OF ......... .,~...~f. ¢{.~..~¢1~ J~...~Q~x--4'. ,4J...T-'~.. .......... being duly sworn, deposes and says that he is the applicant' (Name of individual signing contract) )ore named. e is thc ......................................................................................... (Contractor, agent, corporate officer, etc.) ' said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this · plication; that all statements contained in this application are true to the best of his knowledge and belief; and that.the )rk will be performed in the manner set forth in the application filed therewith. ,,om to before me this .............. ¢.. I .... .......%.. )tary PublJ .ff.. ~ County Notsry PubJi~, Slale ~t New ¥~ ..... ........ · · · .................. No. 4844751 (Signature of applicant) OuaiifieO in Suffolk County Commission Expires Jan. 31, 19'~