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Home My WebLink About23371-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPAgTMENT TOWN PAl/ $OUTHOLD, N,Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date 23371 Z .............. ,=,-~,~.-...,..... ..................... at premises ,oeated at ......................................... ~~.~'..'~..'. ....................................................... ................................ ,4 ~...~./... ... CounlyTaxMaPNo 1000 Section .... ...../~.,.~,...~.B~ck ........ ~ ~LotN(~;c~.a~.,...r~.~...i~ Building Inspector. Fees ........ .P...- .~.... Rev. 6/80/80 BOARD OF HEALTH ~l~~p'5~ TOWN OF SOUTHOLD SURVg~ ................... ~l ..... I~ BUILDING DEPARTMENT ClIECK .................... ' q II ~-~ IJ~]~ TOWNHALL SEFTIC FORH .............. .... ~ I , , I/ TEL.: 765-18~2 D a~ ~/" ..~..... ..................... is, I proved a/c ................... · ;/ . ..... ...... INSTRUCTIONS a. This apl~lication 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 location of lot and of buildings on premises, relationship to adjoining premises 6r pnblic s6'eets 0r areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be comlnenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will igsued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout tim work. e. 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 ttEREBY MADE to the Building Dep~tment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southbld, Suffolk County, New York, m~d otber applicable Laws, Ordinances or Regulations, for the construction of bnildings, additions or alterations, or for removal or demolition, as herein described. The applicaut agrees to comply with all applicable laws, ordinances, building~ housing code, an6 regulations, and to admit authorized inspectors on premises and in bu~ for~ecessa~ insp/ct~] . -- . ( ~ .. : / (gignature of applicant~ name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lesse~i~rcbitect, engineer, generai contractor, electriciau, phnuber or builder. ....~ ~ ..... : ............................... ......................................... .................... (as on the tax roll or latest deed) lf~a~2 is a co~oration, signature of duly authorized officer. Builder's License No .......................... Plumber's License No ..... ' .......... .......... Electrician's License No ....................... Olher Trade's License No ...................... 1. Location ofland on wllich proposed work will be done. . '..~.foS ~",~..F'~4~-- b/t-~ ~.~.~.~.. ~.~. '//qq~ ' . . . llonse Number Street Hamlet Cotmty Tax Map No. 1000 Section ~.- ~-~ Block~o~q.."~-.-..~f Lot ................... Subdivision ' Filed Map No ........... . .... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed cons?uctioll: a. Existing use and occupancy .... f~ ................ t'.Y:~l I~; O~M~ ;~3~f.~W¥~ .................... b. Intended use and occupaucy ~ ~ ~ ~& ..................... ' .... '" '~ ' '.,,.-~.g d$"t~ ~q~a:"' ' m~f~T ..................... 3. Nature of work (check which apphcable) New Bui ding } · · Additln- Repair .............. Removal . n .... lm~ ;~ t~{~[~,~.~. " tl4¢~ o~'r/~.- ~r ,~'5~' ' ':'~' " ~': ...... "" .... : ....... ~,'.~ ............... ~ I ,-, . ' ,t . .,~ ...... (Description) 4. Estimatea cost . ,F--/~..~,)ef'7'~'-e9 . g~ r~ ~ t~ :'- }ir. ia r'r , ........................ ee .............. ,-.~..,: ...... .-; . . ' · (to be pa!~ o,~ili,,application) ' 5 If dwelling number of dwelling units Number ~- · .... · ' .............. o! awenmg units If garage lmmber of cars ' ' ' 6 If business commercial or mixed occupallcy specify nature and extent of eec 1 type of use 7 Dinlensioiis of existing stmct'llr~s if any: Fr'ont Rear ............... ' ..... lleigllt Nmnl~er .... : ........................ Depth .......... of Stories ' Dimensions of shine structure with alterations or additions: Front ' Rear Depth ' lleigbt .................................... ' ' ' Nnmber of Stories ' ' 8 Dimensions ........................ · .............. "' · .................... · of entire new constlruct~on: Front Rear ' Depth lleigbt Nmhber of Stories ............................................. 9. Size of lot: Front ................... ~ Rear ............ ' Deptll ......... 10. Date of Purchase ...... ~ ......... ~ ........ '. Name of Former Owner ................ 11. Zone or nse district in which prmrlises are situated ............. . ..... ' ........ 12. Does proposed constructio~ w. ohte any zoning law, ordinmice or re.u at on' 13. Wi otbel'earaded . /%~O1 .... o .... . ...... :5 .......................... ...... Z~I ' · ' ; ..... 2 J ; ~ ..... Will excess I1.[1 De renloveu Iropl premises: Yes No 14. Nmne of Owner of prelnises -]~0,e.O.ff. OS~ .~.,{°~.~L-~.' Address,3~{t,l~.,~f~a.r..~.:..t~.~one No .~"'. ?~. -.1~1'7,.... , Name of Architect i ' , .'. Address .......................................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ............ .... ' t.s this property within 300 feet of a tidal wetland? *Yes ........ NoM~..,.. · If yes, Southold Town Trustees Permit may be required. '' PLOT DIAGRAM Locate clearly and distinctly alli"buildings, wbetlmr 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. 15. STATE O F COUNTY OF, ............... ,.J~.O..~.o.<~ ....... i. being duly sworn, deposes and says that he is tile applicant (Nmrte of individual signilig contract) above named. ontractor, agent, cur )orate officer, etc. ' of saki owner or owners, ~d is duly authorized to perform or have performed the saki work and to make a ~d file fifis applicatio ~ that all statements contai0ed in tliis application are frue tO the best of bis knowledge and belief; and that the work will be performed in the manner Set forth iu the application filed therewith. Swum to before me tbis~