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Home My WebLink About23098-Z TOWN OF $OUTHOL~ BUIL~ING DEPARTMENT $OU?i'I~D, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) N? 23098 Z .~.,.......~~....../....~.../.../..~. ~ CountyTax Map No. 1000 Section ......... ~../.. ...... Block ............. ~ ........ LotNo._~.,,,~,,.~... ............... Building Inspector. F~ ~..~.~...~ .... Rev. 6/30/80 ....... -'*'-"-*J SOUTHOLD, N.Y. 11971 ELDG D¢' 'h ~ Am O~ r*, '~' ~ TEL,: 765-1802 FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT,. TOWN HALL Disapproved a/c .... . ..... ~ .................... _./.~_ . . _ . . ~..__~ .] .... .. ..... .............. . .......... . .~ ~./...,:-~r....7/. ? - ' ' ~LICA~ION FOR BUILDING'PERMIT BOARD O.F ItEALYtt ......... ,~3 SETS OF PLANS ......... ~SURV£Y .......... SEPTIC FORH ............. tlOTI FY '7~$ c^L~ ~ ........ nAiL INSTRUCTIONS a. Tiffs application must bi~ 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 sdhedule. b. Plot plan showing location of lot and of I~uildings on premises, relationship to adjoining premises or public sti-eets or areas, and giving a detailed description of layout of property muit be drawn on the diagram which is part of this appli "cation. c. The work covered by this 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 thc premises available for inspection throughont the work. e. No building shall be occupied or used ill 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 fro- the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southbld, Suffolk County, New York, m~d 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 regulations, and to admit authorized inspectors on premises and in building for necessar~ inspections. ;, · . · ' ' ............... -- (Signatur9 of~pplicant or name, if a corporation) (Mailiqg address of applicant) AJ % I1¢.~ State whether applicant ~s owner, lessee, 'agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of premises ~r~ 6:, ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer.· (Name and title of corporate office?) Builder's License No .......................... Phnnber's License No ............... .......... lectr c an s L cense No ....................... Other Trade's License No ...................... I. Location of land on wlffch proposed work will be'done ....................... ,~ ' ' o. ri ~Q ' ' ...... ... (v..&.5. .... ~,J-k~ /Sl~d, ~o. s4 ltouse Number Street Hamlet Cot,nty 'TaxMaoNo. 1000Sectlon_...' · ..c~.'! ' Block .._..~ . ~ r.~ :,o,, ......... . ................... ................... Filed Map No..5.(-0.4.( ...... Lot...~/ ........... 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy nq b. Intended use and occupancy ......~'~.ry[ ~.~. ...... .. .... ~" ' ~ '-- ~ .........."~- -t:~ucaum): lxiew Dulldmg · - Addition .... ~terat on Repair ~ · ............ Demohtmn .; ........... Other Work ~:~ ........ ' ..... Re.ova , · · ' ...... '' '' :'-... I ~ ~ ~ ~" .... ' 4. Estimated Cost . sc~ (to be pa d on filing tb~,~licafion) 5. If dwelling, number of dwelling units ..... ~ ........ ; Nug~ber of dwelling units on each floor '..' ......... If garage, number of cars .................... ' ............................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type o 7. Dimensions of existing fuse ..................... structures, if any: Front ....... i ....... Rear · ·. Depth. tteight ............... Number of Stories ', ~:" ...................... Dimensions of same structure with alterations or additions: Front ................................. Depth.. ' tleigbt ..... ..,: ...... · ................ Rear .................. · ....; Number of Sto~es .......... . ~ .......... 8. Dimensions of entire new construction: Front .......... ' Rear ............... Depth tteight .. Number of Stories ......... ' .............. 9. Size ofl0t: Front ......... ~ .......... ~ Rear ....... ' ................. : .......... 10. Date of Purchase ' · · .....; ........ Depth ...................... .................... ' ........ .. Name of Foyer Owner ..... 11. Zone or use district in which premises are situated .............. ' ................ : ....... Does proposed construction violate any zoning law, ordinance or regulati~: Will 16t be regraded ............................ ....... ; .................... Will excess fill be removed from premises: Yes No Name of Owner of premises ............... ~. · · · Address .................. Phone No ............ Name of Architect ............. . ·. Address Name of Contractor ................. '.. Phone No ................. · · ......................... Address ............. ...... Phone No ............ ' .... tS. I.s ~his proper~y within 300 feec of a ~idal wetland? *Yes ........ No..~ .... · If yes, Sou~hold To~n Trustees Permi~ may be required. ' ... PLOT DIAG~ Locate clearly and distinctly ~1 buildings, Whefl~er existing or proposed, ~d. indicate ~1 set-back d~ensions from property ~nes. Give street and block number or de ' to deed, and show street n~es and indicate Whether FEE: ~ ~ BY _(~ NOTIFY SUILDING DEPART 765-1802 9 AM TO 4 P~ FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR ~URED CONCRET~ 2. ROUGH - FRAMING & PLUMBING 3. INSU~ON 4. 'FINAL - CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUC~ON ERRORS STATE OFNEW YORK, COUNTY OF .... S.S · .. B.a..4%.. ' Dzen/<o. . s t< t ..................... ' ......... being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) ]bore named. leis the ~. cOr/~r' . (Contractor, agent, corporate officer, etc.) ............... ~f said owner or owners, and is duly anthorized to perform or have perfomed the said work and to m~e and file this q~plicafion; that all statements contained b tbis'appI'cahon are t'rue tO the best of his ~owledge and belief; and that the · ork wUI be perfomed m the m~ner set fOrth in the application filed therewith. ;worn to before me this ........ · .. ........ . ..,,, ,, . ...... . . . MICH~F[ T. BU~K~ ' · · , ............... . ...... . Ho, 4742712