HomeMy WebLinkAbout26111-zFORM NO. 3
TOWN OF SOI~HOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 26111 Z
Date OCTOBER 29, 1999
Permission is hereby granted to.
JOSEPH GERGYES \
1 75 PiNE NEC,< RO D / /
for : SOUT.OLU,NV 11971~/
DEMOLITION OF AN EXISTING DWF. LLING AS APPLIED FOR & TO THE COND.
OF THE DEC & TOWN TRUSTEES.
at premises located at
County Tax Map No. 473889 Section 070
pursuant to application dated SEPTEMBER
Building Inspector.
1575 PINE NECK RD
SOUTHOLD
Block 0005 Lot No. 041
9 1999 and approved by the
Fee $ 110.90
Authori~~
Rev. 2/19/98
ORIGINAL
.FORM NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTM~NT
TOWN HALL
SOUTHOLD,' N.Y. . 1 !97~
TEL: 765-1802 ~
APPLICATION FOR BUILDING PEI~MIT
INSTRUCTIONS
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEY ........................
CHECK .........................
SEPTIC FORM ...................
¢ NOTIFY:
CALL ~. .........
MAIL TO: ....................
a. This applicatic~ must be caupletely filled in by typewriter or in ink and suhuitted to the Pxfilding Inspector wi
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing locatlo~ of lot and of buildings ee premises, relationship to adjoining premises or public
streets or areas, and giving a detailed deseriptiom of layout of property must be dra~n on the diagram which is part of
this application.
c. 'lhe ~ork covered by this application may ~ot be cc~mesced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
pem/t shall be kept ee the premises available for inspection throughout the work.
e. No l~ilding droll be occupied or umed in ~hole or in part for any purpose ~hatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLIC2ffI(lt IS HE~ MAIE to the Building Department for the issuance of a Building Permit parsxmnt to the
Building Zo~ Ordinance of t~e Town of S~athold, Suffolk Cc~nty, New York, and other applicable Laws, Ordinances or
Ragulatians, for the coustruction of buildings, additions or alterations, or for removal or demlition, as herein
described. The applicant agrees to cauply wlth all applicable laws, ordinances, building code, housing code, and
g~.~ X-~gnature ~Y~fl.~.~cant, or naue, if a corporation)
f,,~ ~.~.,~ ~' ~ ../..~..?..--~.7(Mailing ..... address/~'"~"~'¢"g~of applicant) .... "~'~/'" ........
State ~/mther applicant is ~mer, lessee, agent, architect, engineer, general contractor, electrician, pluuber or builder
........ ~..~.~.~.~.. ................................................................................................
(as ou tbe tax roll or latest deed) , Aflt}~6~D AS NOTED
(N~e and title of corporate officer) /.~f . .., !~ ?$E-1802 9 AM TO 4 PM ~OR THE
Builders License No ........... {- ~ ~.--, .... ?/.~..~_~. ~ FOR POURED CONCRETE
.~ .......... //~ ¢/ z Roueu. ~RA~m6 & P~UMmNe
Plu-~ers License No ............
Electrlclans License No ......... ~..~. ~---~/~- 4, FINAL - CONSvHUCTION MUST
E~ COMPLET~ FOR C.O.
Other Trade's License No ..................... ALL CONSTRUCTION SHALL MEET
I, Location of land o~ ~hich proposed work w111 be doae .......................... .T.H..E, .I~E. 0~I$[B~M~..bJT$..0~..T.M~..~ .Y,.
· ~ STATE CONSTRUCTION & ENEBGY
................. ..... ............
........... -~f~p~ c6~'0~-i6h' ~'.i~'!~E
tk~se Number Street
c~ T~Map NO. ~000 ~tlon .,V.P .......... mo~ ..,.~.~.. ....... mt .,.~.1:,~ ......
~bai~isi~ ............................... : ...... Fi~ed MaP NO. ~..~.7. ........ ~t ...¢, ..........
(~ame) :
2. State existing use and occupancy of premises ~ intended use and 6ccupancy of proposed construction:
a. sting ee , .... ........
b. Intemded use amd occupancy ..... ~ .............. .. ......................................
P;Jture df ~rk (cbeck which applicable): New Building .... Add|t~on .... i ..... Alteratlon ..........
~. rRepair ............ Removal ............. Demolition ...,........ Other Work 'i ......................... .......
~, , ,~ ,I (Deaerlption)
i (to be paid on filing ihis application)
i'.,i. ' Tf a~liing, r~r dS ~11ing ~mita ............ t~r of ~elling traits on ~ad~ floor ................
If garage, atelier of cars ......................................
If brininess, cOm~r~ial or mt~d occtroancy, apaet6.t nature m~d extent o~ ead~ type of use....~..: ..~...' ..........
lhmae~ona_ o_f ~ structure Mtt, alterations or addltions~. '~ont . ,2~,$'.' ,~ . !., Rear eT(~.. ! ,
.~ i' ' '~'. ' ~;~'~" '"~7 ......... ~r o~ ~,or~e~ ...~...~..
Dnrens~ona of entire n~tructiou: Pront ....... ...... ~ar
lhi~t ......... ~r of Stories
Si~ of lot: ~t .................... ~ar .................... ~pth ...............
3.
~te
Of
..................... ~ of Four ~r .................... ~ ....................
I. ~ or u~ district in ~i~ pr~i~s
~. ~s Mo~ mt~ti~ violate any ~i~ 1~, o~i~e or re~lati~: ..I ..................
L Will lot ~ ~·
i. ~s of ~r of ~s. ...... -- -................. ~rese . ................
~ of ~ddt~t .................................... ~ress .................
~ of ~tr~tor ................................... ~ress .................
L Is ads p~rty ~thln ~ f~t of a tlal ~tl~? * ~ .......... ~ .........
PLOT DIAGRAM
I~cate clearly and distinctly all lmildlngs, whether existing or proposed, end i~dlcate all set-back dimensions
property lines. Give street and block ntmt~r or d~scription according to deed, ard slmm street n~es arat indicate
ether interior or corner lot.
.................. being duly s~ru, deposes aml
~ays that he {s the appl icant
(CxTntractOr'if.t~g~ff~.} corporate officer, etc. )
.~ai~l c~a~er or owners, and la duly.,~thor~ to ~rfom or h~ [~rfo~ the ~id ~ m~ to ~ke a~ fil. e this
,licat{~q tha~ all stat~(~ta c~a.~ in this a~].icatlon are
~t the m~ wili be ~r[o~l .in, the3mm~r ~t forth in the a~l. lcatim fil~ tbe~
)m to ~fore ~ 'this '.:M:'
...... 2 ........ ,,,~ o~ .~ep./ ....... ~9. ~f..
........ .......