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Home My WebLink About22691-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o 22G91 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ................................................................................. ~.~..~.~. ~': .... pursuant to application dated .......................................................... ] g....~.~, and approved bythe Building Inspeotor, Fee,,,~ ....... / ~/ Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .... '~/.a .a .~. ....... 19 .?.,.~ ....... Approved ...... /,-.,-. ....... , 19~. Permit No. ,)-3/aQ DisapprovedI a/c ................................ ~ .... BOARD OF HEALTH 3 SETS OF PLANS SURVEY ...... ; ............ ClIECK ·. lq. ...... MAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS · Builder's License No .... ............. ' ......... Plumber's License No ......................... Electrician's License No. Other Trade's License No... .................... a. This application must be completely filled in by Wpewriter 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 or public sti'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit shall 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 shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describbd. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary int~tions. ~ j .. . , (Signatul'e of applicant, or name ifa corpo.r~tion) .. · (Mailing address o~f a~plicant~ State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of premises ....... - . !'. .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 1. Location ofiand on which proposed work will be'done .... ' o qqs- 5v,Wrw ' v -ca c/e .'' House Number Street Hamlet County Tax Map No. 1000 Section I 0 ~ Block Subdivision ~&~'..~..~'~, .(~.. ' Filed Map No .... g/.7.~ ..... Lot...t?.~ ....... (Name) · 2: Statd ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy b Intended use hnd occupancy P .............. Re~oval .............. Demolition ..... ; ......... Other Work~.~gqO!E. · ' ~'~O(~i ~- '"" (D ipti ) 4. Estimated Cost ........... ' escr on · ] ......................... Fee ................ be paid on filing this application) 5. If dwelling, number of dwellin¢ units ............... Number of dwelli(nl:units on If garage number of cars I ' each floor ................ If business, commercial or mi.x~d occupancy, specify nature and extent of.each type of use 7. Dimensions of existing structutes if any: Front Rear .... . ..... ' ..... Height Numl~er of Stories ............................. Depth Dimeasi;~ ............ ' ................... ' ........................ J J ........ of shme structure ~ith alterations or additions: Front ......... Depth ' ' Height .................. Rear .................... ~ .................. Number of Stories 8 Dimensions of entire new constiruction: Front .... ' ' ' ' Height ' Number of Stories .............. ; Rear ............... Depth ............... 9. Size of lot Front ' p~,~, . 10. Date of Purchase .. ~.L.' ........... uepm ................. ,. .... · ...... [ .................. rqame ox vormer Owner .................. 1 1. ,cone or use alstrmt m wh,ch pr~mises arc situated .............. ' 12. D.°.es proposed construction violate any zoning law, ordina~ce'~'-'--",'~. ' ...................... . .... [ ut regulation' . .... '13. Will lot be regraded . · ..... ' ................... '- · · ' ' :~l ....... :~2.~, .......~. wm excess fill be remo¥cd from premises- Yes ' , No 14. Name ofOwnerofpremises~.~o. [ .~.O.~?da4,q .... ~.~Vr-~,~ ~'a_~,~r~, .. '-~,~_, ~. ne No ................ Name of Contractor ......... i ............ Address ............... ._..,.. Phone No ............ ' .... 15.' Ip this prnperty within ~00''f~t' of d tidal wetland? *Yes...~-~.... No .......... · If yes, Southold lown Trustees Permit may be required. ...· PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot, STATE OF NEW Y_OI?,K .... 7: 'i ...... ' ..... (Name of individual signing contract) above named· APPROVED AS NOTED NOTIFY BUILDING- O~p~~ 7~5-~R02 O A~ ~0 4 PM FO~ THfi FOLEOWING INSPECTIONS: I. FOUNDATION . TWO REOUIRED ' FOR POURED CONCRETE 2, ROUGH . FRAMING & PLUMBING 3. INSU~TION 4,*FINAL . CONSTRUCTION MUST BE COMPLETE FOR' C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR * DESIGN OR CONSTRUCTION ERRORS being duly sworn, deposep and says that he is the applicant He is the j .~..,~. ~ ' ' .' I (Contractor, agent, cor'porate officer crc ) .......................... )f said owner or owners, and is duly aiuthorized to perform or have performed the said work and to ' tpp!icat:,,o,n, that all statements~contamqd m this'application are true to the best oChis kno-,'~,~ .... .~ ~m_,,ak~e and. file thru · ' ' ' = ; ,~uu,~ anu ucueI, and that th ;vor~ v?~ .Oe?erformed in th..g~-'~nner s~t forth in the application filed therewith. ' , e ~worn to oemre mO this / / r' // '. ' N~ARY ~ lC, Siate of N.Y. '~'~=~:.-;..~ ........ ~..~j ..... .__~: