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Home My WebLink About23215-zFORM NO.3 TOWN OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE ~,,~DRK~IZED] Ne 23215 Z Date ...... ..~......~....~... ................. 19.,,~..~... ~---- , FORMNO. 1 ;3 ,~ET$ OF PLANS , o 7' ........ : ........ ~Jl I~ BUILDING DEPARTMENT /CIIEcK ................. ~J~ - J :,'~ TOWN ttALL SggTIC FORII ............ L~I ~' JJ [g~ SOUTHOLD, N.Y. 11971 , J I TEL · 765-180~ tin,_[ ~Y ~ ~/_~ ~ i .... ! " ~;.,~ /~ ~ //~ ¢/~/ , '~/ ~/~ .. ~. ~/~/.~. Approved ........... , JgZ~l'el'mJ[ No.~.~. ...... ' ' . ~j~ 5f ' .......... ui~pp~o~.d ./o .................... ~ ............ ~,N, / PLICATION FO~ BUILDINGPE~IT INSTRUCTIONS a. This applicatiou umsl be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit sets of plans, accurate plot plau to scale. Fee according to schedule, b. Plot plan showing location or lot and of btdldiugs oil premises, relationship to adjoiniug premises or public s{rc or areas, and givlug a delailed descriptiou of layout of property must be drawn on the diagram which is part of Hds ap calion. c. Tim work covered by tlfi~ ~]pplicalion may not be commellced before issuallce or Building Permit. d. Upon approval of this applicatiou, the Buildiug luspector will issued a Building P~rmi[ to the applicaut. Such per shall be kept on the premises available for inspecfiou Ihroughout the work, e. No building ~hall be occupied or used in whole or iu par{ for any purpose whatever until a Certificate of Occupa shall bare been grouted by the Buildiug luspector, APPLICATION IS tlEREBY MADE to the Building Deparlmeut for the issuance of a Buildiug Permit pursuaut to Buildiug Zoue Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordiuance Regulations. for tim construction of buildings, ndditiuus or allerations, or for removal or demolitiou, as herein descrit Tim applicant agrees [o comply wJlb nil applicable law~, ordir;ance~, building code, hou~h]g code, aud regulalious, an( admit attthorized inspectors on premises and in building fornecessary iuspectionm ~ ~) (M~iling address of applicaut) Slate whether appllcarlt is owner, lessee, age,l, archilecl, engiueer, general contractor, electrDia,, plunH)er or bull Name of owuer or pre,lises I' Y/c~-r'ee ~ (as on tile tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, (Name aud title of corporale officer) lluilder's License No .......................... I It al)er s L ce lse No ......................... Elect 'ma i s L cease No ....................... Other 'rrade's License No ...................... I. Location of land on which ploposed work will be done .............................................. · ............... C &, .. q. g. ................................................ ltousc Number Street llamlet Couuty Tax Nlap No. I000 Sectiou .... '~* ~ Block ~ Lot 2 / .~ Subdivision .............. '. ...................... Filed Map No ............... Lot ............ (Name) 2. State existing ose and occupancy of premises and intended use arid occupancy of proposed construction: - , . CeO n. Ex~s[mg use m~d occnpancy ................................................................. b. Intended use ~nd occupancy ............................ .~;~ ~, .. ~. ,~ ...... . ................... 3. Nature of work (check which applicable): New Bnilding .......... Addition .......... Alteration..,.. .......... Repair .............. P,.em o',,al .............. Demo,rio. .............. Otl, er att]l .". .... -.. (Description) 4. Estimated Cost .. ~ fCr. ~[~ ~ Fee ~ ~'. ........ ~a. ,,... (to be paid on 5. If dwelling, number of dwelling units ............... Number of dwelling nn~ts on each floor ................ . If garage, number of cars 6. If Business, commercial or mixed occupancy, specify nature and extent of each type of tide ..................... 7. Dhnensions of existing structures, if any; Front ............... Rear .............. Depth ............... lleigbt ............... Humber of Stories ........................................................ Dimensions of same strncture with alterations or additions: Front ................. Rear .................. Depth ...................... fleigbt ...................... Number of Storied ...................... 8. Dimensions of entire new cooatruction: Front ............... Rear ............... Depth ............... lleight ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase .................... ' ......... Name of Former Owner ............................. I I. Zone or u~e district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulalion: ................................ 13. Will lot be regraded ..................... > ....... Will excess fill be removed from premises: Yes 14. Nam~ of Owner of pre,ni~e~ .~ql4(<~.~q(~*.... Address ~.~l?.~fvfCU..~.. ~l;~one No.(4q¢ Name of Architect , . .)9~ ({ , Address I< <oo,~5' ~o mD/e~hmne No Name of Contractor .......................... Address ................... Pho[~ No ................ ~[[ yes, Soucbold Teen Trnataea Permit may ba required. PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from proper/~ lines. Give street and block nttmber or description according to deed, and show street names and indicate whether Mlerior or comer lot. tS. '2OUNTY OF ....o. ~3'~'.~..~. ..... S,S ......... ~ ..................................... being duly sworn, deposes and says that he is the applicant (Name al mdlvldtnd sign ng contract) ................... ' ~1' said owner or owners, and is duly aulborized Io perform or haw p~r[ornsad tim ~aid work and lo mak~ and ~il~ Ibis lpplication; that all statements contained id this applicalion are /rue to the best of his knowledge and belief; and that the ~ork will be performed in t~lifanqer set forth in the application filed therewith. qwom to before me/his/I ~..., ' ~otary 1~ c Couubli ', ....................... J