The URL can be used to link to this page

Home My WebLink About22773-ZTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HA~ $OUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby~: ~ //~ // ../~.. ~..~.~,~£~........~.....~/./..~ .................. ...~...~....., .,~.:.....~.~...~...: ................................ ,_~ ......... ~ ~:.../.........~.,..~......../...~.o......?.~-~, --,- ....... ,,~,~...~,..~,~...~... ~....~ ..... ..... ~.....~..~ .~....~-~ ................................................................................... ;;';: :;;; ;' ::.'.'.'.'.'.'.'.';. ;.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'. ..............................................................~ ~~..~..~.~...~.~. ...... ~.,...~... .................... ~o~n~Ta×Map~o. ~000 s~t,o~ ........ ....~-~.. ..... B,~~.. ........... Lo,~o ..... ./.~. ............... pursuant to application dated .................. ~,,~......., 19.~, and approved bythe Building inspector. Fee $ ........ ~...~ ...... Building Inspect~;~ Rev. 6/30/80 // FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Disapproved· a/c ................................ ~..;. ~g Insp ' A~CATION FOR BUILDING'PERMIT MAIL TO: Date . ..... i9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 Iocation of lot and of buildings on premises, relationship to adjoining premises or public st?eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli. cation. c. The work covered by tbJs application may not be commenced before issuance of Building Permit. . d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ¢. 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 South01d, .Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions 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 reoulations and admit authorized inspectOrs on premises and in building for necessa, w inspections, f-~ //~--...--;~--o-.- , to (Signature of applicant, or name, ift~orporatio'n') .... (Mailing address of aplMicant) State whether applicant is owner, lessee, agent, architect, engineer, general ·contractor, electrician, plumber or builder. (as on the. tax roll or latest/deed) ................. If applicant is a corporation, signature of duly authoriied officer.· , , (Nam~ a~ titlg of corporate officer) Buildir's ense No... Plumber s hcense No .......................... Electrician's License No...7. ................... Other Trade's License No. '-- . .......... I. Location ofland on which proposed work will be done ........................ ....... House Number Street Hamlet County Tax Map No. 1000 Section ...: .............. Block .3 ' Lot / ~ Stbdvson ~ ' Filed Map No. (Name) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed constructioni a. Existing use and occupancy ... /~ff:3- / /')f/t/ c ~ · . ~ ~ '3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair Removal ...... Demolition . . Other Work...5..~-~. ~ ~ ..... 4. Estimated Cost O O ~- ~0 (Description) 5. 1 ~ ~ r of welh g yn ts on each floor ............. 6. ' ess, commercial or mixed occupancy, specify nature and extent of.each type of use .. 2.--7 ................ 7. Dimensions of existing structures, if any: Front... Height ............... Number of Stories .......... ............. Dimensions of shme structure with alterations or additions: Front ~-- ' ......... Depth ' · ................. Rear .................. ...................... Height ........... · ........ ;., Number of Stories ........... ; .......... 8. Dimensions of entire new construction: Front ...~. .......... ; Rear ............... Depth ............... Height ............... Number of Stories .......... 11. ~,.~ ur use msmcr ~n wnicn nremises are situated 12. Does proposed construction violate any onim, law ~,a:-._'_ ' ' '; .' ......f,',~ .......................... 13. ~ z ...... o ----, ~umam:e or regulation: .. zY. ~. ............ Will 10t be regraded · ..,,~. ....... 7/'> 2;- .............. wm excess Cboe ren3pved from premises: '-- Yes No 14. Name of Owner of premises ./TP././.?./.. ................... · ~uuress ................... Phone No ........ · . .' Name of Contractor ..... ~ ........ Address ........ · .. Phone No ............ ' ..... ~.5. I.s th±s property with±n 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 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 corner lot. rATE OF NEW YORK,, · /~..~..,~'.<~..&....~..:.~.O/'~.~ ......... . ......... being duly (Name of individual signiffg contract) )Dye named. BE COMPI..~i ~. FOR C.O. AH. CONSTRUCllON SHALL MEET THE REQUIR[tdEN'r8 OF 1HE 'N.~, STATE CONSTRUCTION 8, ENERGY CODE~. NOT RESPONII. E FOR DESIGN OR ~ ERROR~ CERTIFICATE sworn, deposes and says thali he is the applicant is the (Con-tr. amor, ~g~,t, ~o~te officer, ets.) said owner ~ is duly authorized t ---~-- · ' ~ w"~~~--~Wgr~ to m~e and file this plication; that all statements contained ~ this'application are t'rue tO the best of his knowledge and belief; and that the xk w~l be perfo~ed in the m~ner set forth N the application filed.therewith. /om to before ~e th~ ...... .......