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Home My WebLink About22703-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22703 Z Date ........... , ..~..../~..., .~.. ............................ Permission is hereby granted ~', /) ~ . ...~.~..~..,.~c..i ........................................... ,o..~c~.~ ...... ~ ........... ~~ .......... .z.~ ........ ~,~,..,. ........ ~. ............... ~ ~~ ........ ~. at premises located at ................. ~..~..Z~......~~..~....,...~ ................................... ........................ ~ .............................................. .~.~./.~4..~...~ ............................................. CounlyTax Map No. 1000 Section.../..//.. .............. Block,,,...,~..~.. ............ LotNo ....... ..~....~.,. ........... 19......~....~...., and approved bythe pursuant to application dated .................. .~...l..~.i ............................ Building Inspector. Fee S..,..Z.,,~.~ ..... ~~pector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ...... ~..~. ~. .... 19 .~.~ ...... Disapproved a/c ..................................... BOARD OF HEALI'H ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS ,a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 or public streets ,r ~areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be c'bmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall be kept on the premises available for inspection 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alteratio~rm,-o~for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable taws, ordinan~s, bulldog code, housj~g-'~de, and regulations, and to dmit authorized inspectors on premises and in building for necessary in~ [~/~rk.- (Sig~nature of applicanl, or name, if a corporation) · .... ~ (M~hilin~ address of appl ...... // U ,tate whether appucant is ownS, ~ssee, agent, architect, mengineer general contractor, eleci:i'i}~builder. ame ofownerofprem,ses ...~Z'/.~ ..... /~~...DA'[E:.~.B:P..~. .... , ..... ' (as on the~ .ax~roll or latest d~fl.~ ,.'~, ~ By.,~.-~-'~.~ - £ applicant isa c..orporation, signature of duly authorized officer. .' NOTIFY SUlLDI-N~--""'f'"-"'"'~%2'";JE · 76B-1802 9 A~ ......... .~... ................ FOLLOWING INSPG~'IONS= (Name and title of corporate officer) 1. FOUNOATION - TWO REQUlItEO Plumber's License No ..... ./~.../~. ............... EIectncmn s L~cense No ................ Other Trade's License No....//'?.~. .............. FOR POURED CONCRE'IE z RoUgH - m' Mmf! 3. INSULATION 4. FINAL' CONSTRUI~'ION' MUST BE COMPLETE'FOR C.O. ALL CONSTRU~!0N SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Location of land on which proposed work will be r~one.,,, ...................................... ~ .... House Nmnber Stree~. Hamlet County Tax Map No. 1000 Section ............... Block .................. Lot ................... Subdivision ..................................... Filed Map No. L (Name) State existing use and occupancy of premises and intendeds, ~.7., use a,~nd oc~proposed construction: a. Existing use and occupancy ..... ~ .... ~..~?~ I 'l~j% ..... u. mtenaeO use and occuuancv . . _ _. .............................. .... 3. Nature of work (check which applicable): New Building .......... Addition . ,. Al.~.~ation.,~. ......... Repair .............. Remoyal ............ ... Demolition ......... 4. Estimated Cost ....... . ............... Fee ...................... ~ _~ (to be paid on filing this application) 5. If dwelling, number of dwelling Units ..... ~.. Number o f dw~ units on each floor ................ ' Iflf garage, number of c~s ...... : ..... ~- 7. Dimensions of existing structures, if any: Front .............. ~ar ........... ;.. Depth ............... Height ............... Nuin b~ St~ ............ ~ .......... D~ensions of same stmctur~h alteration~additions~f j j ~ ~ ~ ~ ~ ~ ~ ......... ;22j .................. prn ............... , · ' .............. ..... · ~ ...... ~ei~t ...... ~ .~ .......... Nnmber of Stories ............. ~. ~mens:ons of entire n~ construction: Front ...~ ........ Rear ............... Depth ............... Height .......... ~... Number of Stofies~ .~ ............................................... 9. Size of lot: Front . ~ ................. ~ Rear .... X ................ Depth ..... 10 Date of Purchase L .............. / xr~2~ ~f~_' ~ ' '~ .................... 11. Zone or use distri4 in which pre~ ~5.2TZyTy? ............................... 12. Does proposed coCstruction viol~ zoning law~a~e o~gulati~:' ~ ........... 13 Willlot be re~rade~ / ' - .....- -~ .............................. ...... ~ ~- ...... ~ ............... Will ex~ be removed from premises: Yes No ~. ~me o~ owner o~premif ................... Address ..... ~ ......... Phone No ................ Nme of Architect ~'~, ~ ~o:..-. .............. N~e of Contractor .......... : ................ Address ................... Phone No ................. 15. Is th~s property w~Ch~n 30~0 feet of a tidal wetland? *Yes ........ No ......... · I~ yes, Southoid To~n Trustees PermSt may be required. .... ] PLOT DIAG~ Locate clearly ~d distinctly ~1 b~uild~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y lines. Give street ~d block n~mber or descfiptioh accordh~g to deed, and show street nines and indicate whether ~tefior or comer lot. :Omff¥'pF. (Name of ~ndividual signing ~ontract) ' bove na~ed. ~: ~ ' is the .............. ,, (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly au~thofized to perfom or have perfomed the said work and to m~e and file this fiplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the 'ork will be perfomed in the m~ner set]forth in the application flied therewith. / ~ .... dayo~. ~..~.. 19... otaw Publi . · · · County CLAIRE L, GkEW ~ARY PUBUC, State of No. 4879505 , ~uBlif~d m S~flolk ~ounty ~ ~/ (Si~natu~ o~ applicant) ~mission' txp~res uecemoer f