HomeMy WebLinkAbout30361-ZFOP~4 NO. 3
TOWN OF SOUTHOLD
BUILDING DEPY~TMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 30361 Z Date Y~_Y
Permission is hereby granted
FRANK B ~IMMER
PO BOX 35t
ORIENT,NY 1195[
for : \
CONSTRUCTION~0F A NEW SINGLE FAMIi DWELLING
at premises located at~x
29525
24, 2004
APPLIED
?
FAIN / ORIENT
County Tax Map No. 473889~xSection 0~3
k
pursuant to application dare'MAY
Building Inspcctor to expire oX~VK
Fee $ 1,374.90
ock002 Lot No.
0--07.013
19, 2~04 and approved by the
24; 2005.
Authorized Signatuz e
COPY
Rev_ 5/8/02
t,'i.~LD [NSPECTION REPORT I DATE, i CO~,:E$1Te-2qTS · . ~k] ,.~
FO~ATION (1S~
FO[~A~ON (2ND)
ROUGH F~G &
~S~A~ON
TOV~7~T OF SOUTHOLD
BUILDI]hG DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9562
PERMIT NO.
Examined q/~ ~t
Approved ~.~, 200?
Disapproved Lc
BUD'DING PERM1T APPLICATION CHECKLIST
Do you have or need the follow'~g, before applying?
Board of Health ~._
3 sets of Buildthg Plans
PLaxming Board approval
Survey
Check
Septic Form
N.Y.$.D.E.C.
Trustees
Contact:
Mail to: F~g
~uilding Inspector
APPLICATION FOR BUILDING PERMII
Date
INSTRUCTIONS
20o¥
"~..-~Inis application MYLrST be completely filled in by t)pewdter 9r in ink and submitted to thc Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee accor,ling to schedule.
b. Plot plan showing location of lot and o£buildings on premise!, relationsh/p to adjoi~aing prem/ses or public streets or
areas, and waterways.
c. ~Yhe Work covered by this application may not be commenced before issuance of Bu.ilding Permit.
d. Upon approval of tkis application, the Build/ag Inspector will tissue a BuiJdlng Permit to the applicant. Such a permit
shah be kept on the premises available for inspection througktout the work.
e. No bu/J ding shall be occupied or used in whole or in part for ,any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f._Eyery bmldmg permtt shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been co'mpleted wiflain 18 months fi-om such date. If no zoning amendments or other regulations affecting thc
prol)e~ have been enacted in the inte_~m~ the BuiJding l,_?eetor m_ay autbo_vhz% J~. xx,~tilxg, the ext__ension of the p _¢rm~/t for an
addition six months. Therem°cer, a new pc~m]t shall be required.
APPLICATION IS HEREBY MADE to the Building Department f~r the issuance of a Buildl.g Permit pursuant to the
Building Zone Orciimg. uce of the To~m of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Re,flattens, for the construction of buil,tlngs, additions, or alterations o[ for r~moval or demolition as herein described. The
apphcm~t a_mccs to c6mply with all applicable laws, ordinances, building code, housing code, and regulations, and to aduut
authorized inspectors on premises and in building for necessary inspections.
(SignaLure of applicant or name, ifa corporation)
(lVlailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Oth~.T...radds License No-
1. Location ofland on which proposed work adh bc done:
Honsc Number
County Tax Map ~
Subdivision
Hamlet
Block
Filed Map No.