The URL can be used to link to this page

Home My WebLink About23426-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] 23426 Z Permission Is hereby grantgdJo: ~¢. ., .~ . ...... ~ ................ ~....~: ........................................ ....... ,o .... ~~..~..~.~~~..~.~...~ ....... ...... ~~....~~.....~ ..... ~.~.~..~.~.~ ...................................................................................................... ;~;;2.~.~2;.~;;.Z....Z.7.;.~.......~~.......~..................................Z........................................... ~o~o~o. ,0o0 ~,o~ ........ .~... ~,~ ........... ~ ......... ~o,~o ....... ~.~ ............ pursuant to applloatlon dated ............... .=~ =-~... .......................... and approv~ by th~ ~..~.~..~ ........ .... ~iG';~i;~~ ........... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ....... .~. .... 197.~. Permit No. Disapproved a/c ..................................... AP~L/ICATION FOR BUILDING'PERMIT BOARD OF IlEAL'I'll . . ., ...... 3 SETS OF PLANS .......... SURVEY~ CtlEC~:. .................... Se~'TIC loire .............. CALL · ~¢----.X . ...... HAIL TO: Date .................. 19 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 acco[ding to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn oo the diagram which is part of this appli- catiou. c. Ti~e work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will igsued a Building Pe~it to the applicant. Such permit shall b0 kept on the premises ava~able for in'spection throughout the 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 ~y the Building Inspector. APPLICATION IS ItEREBY MADE to the Bulldog Dep~tment for the issuance of a Building Permit pdrstmnt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, m~d othe[.appli~a~!e Laws, Ordinances or Regulations, for the construction of buildings, additions or altemtlons, or for removal or demolitign, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building~¢e, ~ousing code, and regulations, and to admit authorized inspectors on premises and h~ building for necessa~ i~pec~ ~/~ (Mailing address of applicant) State whether applicant is owner, lessee~ architect, engineer, general contractor, .elec.[rician, plumber or builder. .. ........ ca ....... ::" '"' ';'" ...... '" .......... Name of owner Of prenfises ....... ...... .~.~ .................... r,~.,.~7.~$¥? ,;~* .t · .,. ?-': '' .......... (as on the tax roll orlatest d~[d) If ~appl/[~nt is jq corporation, signature of duly authorized officer. · ...... Builder's License No. Phunber's License No ..... ' .................... Electrician's License No ....................... 8LDG, OEP[ , .......... 7..9~F SOUri~OLO ~ Other Trade's License No ...................... t. Locationoflandonwbicl~p. roposedworkwillbedone......_~....i.~.p ..... ~.~.[ .~.. .... ~ ''" ..... ~~~'~"'!~ ............ ---~:....~..~. - ................ - ....... llouse Number Q.~ . Street }Iamlet Cou,,, T xMap o.,oo0sect on ......... Biock..O. . . ..... Subdivision ......... t'hrt .... Filed Map No... [ ~.,~..,.~ ....... Lot ............... (Nmne) 2: State existing use and occupancy o[~premises and intended use and occupancy o! proposed constrnction: a. Existing use and occupancy..' .-~ ['~ .~... ,-.-,~~..' ~'~"t, ........................ b Intended use and occupancy ...~/~t&.~.lfF_., ~(.,5':w.A~. ~;~.'~~ .................. .3. Nature of work (check which applicable): New Building i Addition .......... Alteration .... :.. i..; Repa,r .............. Remloval ............. Demolition .... Other 4. Estimated Cost ..... q-'; .'T ................ Fee .............. i (to be paid on filing this application) 5 If dwelling number ofdwellingiunits .....-w .... -. Nmhber 0f dwelling nnits ou each floor If garage munber of cars [ .... ' ' ............... ~. If business, cmnmercial or m[xeld occnpancy, specify nature and extent of each type of nsc ..................... · Dimensions of existing structures if any: Front ; Il. ear ' IIeight Nnml~er of Stories ........................... Depth ............... Dimensions of shine stmctme wi th alterations or additions: ..................................... Front Rear Depth ' ' lteight ................................... ............ ' Number of Stories ' 8 Dimensions of entire new construction: Front .......... ; ' ' lleight NuMber of Stories .............. : Rear ............... Depth Size of lot: Front ......... , i 'i .......... Rear ...................... Depth Date of Purchase ...... ' N ...................... ..... . ................ . anle of Former Owner . .. ti ~ ' d ....................... Zone or use distric n which pr mines are situate .................................................... Does proposed construction vioiate any zouiug law ordina {ce or re ' . . . . , , gulatmn .... ~ .......... Will lot be egraded ./QO . , ...... ~ ' ........... ....... i ................. WUl excess IIU efen ovea lro )remlses: NameofOwnerofpremises/t~J'~K~. ~! L~EI~ ,x ...... //,,.9,~, ~e~ ~ #o Yes · ......................... v... o Name of Architect ~ .......... ~. ... Address ................... Phone No ................. Nmne of Contractor i . ......... ~ ................. Address ................... Phone No ................ t,s this property within 300 feet of a tidal wetland? *Yes ..... No. ~.. · If yes, Southold Town Trustees Permit may be required. Locate clearly and distinctly all property lines. Give street and blockt interior or corner lot. / APPROVED AS OTED ' NOTIFY BUILDING 765-1802 9 AMTO 4'PM FOR FOLLOWING INSRECTION$: I. FOUNDATION . TWO REQUI FOR ~URED CONCRETe= 2. ROUGH. FRAMING & ,3. INSULATION 4. FINAL CONSTRUCTION MI BE COMPLETE FOR C.O. ALL CONSTRUCTION THE REQUIREMENTS OF STATE CONSTRUCTION & CODES. NOT RESPON$1BbE PLOT DIAGRAM 4mfidmgs, whether existing or proposed, and. indicate all set-back dimensimls from mmber or description according to deed, and show street nmnes and indicate whether STATE OF NEW YD. Rg- ~..L~.:; ;:- *i ........ ......... . ......... (Name of individual signin coutract) above 'named. ~le is the ..... .................. being doly sworn, deposes and says that lie is the applicant (Contractor, agent, cori>orate officer, etc.) of said owner or owners, and is dnly authorized to perform or have performed the said work and to make and file this applicatiou; that all statmnents contai~ied hi this'application are ~rue to the best of his knowledge and belief; and that the work will be performed in the manner s~et forth in the application filed therewith. Sworn to before me this . '. ' ' No. 4725~89. Suffolk C~/ ' ~ (Signature of applicant) Term Expire, May 31, ~ .. .