The URL can be used to link to this page

Home My WebLink About22632-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 22G32 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ............ /~.~.~ ........................................ Permission Is hereby grante, d to: _ / /) · ,~ ~,...~.. ........ ~z.&.... .............. ~.. .............. to ...~..~..~....~ ......... .~...~......../..~:..~........~.....~..~....~...~.... ~.~ ./..~:....~,4~....,~..~..~...~.~.~.~,.~....,~...~ ~_...~c....~.~.~.~,.~...~ .............. ~ ........................................................ ~'t' ~'~,~';~ 't~' ~.'.'.'.'.~'.'~.~. ~........~;~;Z.....~.....:....'.'.'...'.........`.....`............................................. ~o,n~T~x~,~o. ,000 ~o,,o. ...... ~.~,~o~,.....~ .......... Lot,o..Z~Z.... ........... pursuant to application dated ........... ~.~.~.~ .......... 19...~..~and approved by~e Building Inspector. Rev. 6/30/80 Building Inspe~or BLDG, DEPT. TOWN OF SOUTHOI-D FORM NO, 1 TOWN OF SOUTttOLD BUILDING DEPARTMENT SOUTIIOLD, N,Y. 1197] TEL.; 765-1802- Disapproved a/c ................................ : .... ~ ~ing I~ '~- ' ' · /~PDI ATION FOR BUILDING PEFIMIT INSTRUCTIONS BOARD OF IIEALTII 3 SETS OF PLAitS SURVEY ............. CIIECK .................. SEPTIC F 0 R,'I ............ :2 Ig: 727 CALL . ...... HAIL TO: Date .................. , a. This apI}lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildh~gs on premises, relationship to adjoining premises or public sti'eet, or areas, and g. iying a detailed description of layout of property must be drawn on the diagram wliich is part of this appli cation. c. , The work covered by tlzi~ application ri'my not b~ oommenet~d bofm'e~ l~m.mnee of Bulldtng Permit. . d. Upo~l ~tpprovfll of 1,1111~ tll~plloatlorl, tile Building Inspector will t,~ued a Building Permit to tile applicant. Such pennlt slmll bo.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 ti~ve been granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ~e 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 described. 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 inspections. (~ ~. /~r~T o~ _2 . . (Signature of applicant, or name, if a corporation! (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder· Nme of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant~a corpo./ation,~signature of duty authorized officer. · . ' (Name aM title of corporate officer) Builder's License No..~4 ................... Plumber's License No ........................ Electncmn s hcense No ....................... Other Trade's L!cen~e No. 't' "~ .... 1. Location of land on whicli proposed work will be done ............................... ' ........... ltouse Number . ~ Street Hamlet Connty Tax Map No. I000 Section :,../~.~ . . .. Block .. ff Lot ...... ~... '~ Filed Mai) No. ~ Lot ...... : ........ - Subdivision ........ . ............................. (Name) 1. State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy .................................................. · .:3. Nature of work (check wh ch applica ......... '' ' ~ . Die): New ~uuuing ........ Add t on . A Repair .............. Removal r', ....... ' ' ' .... 2 ' ' ' ter~ion 4. Estimated Cost ..... ~"" ............. Fee .. . . . ( paid on filing this application) If dwelling, number of dwelli~ng u ~ ts ~" ~ Numbe ~ ge, number of cars ..;.....-. ...... ~welbng umts on each floor .... ~.. 6. If bus ~ ess commerc l or mt~ed occupancy, specify natnre and extent of each type of use ...' .. ' . ' .... Dimensions of exlsting stmctbres, if any: Front .............. Rear .............. Depth ..... ' ' ' ' Height ............... N~m~ber of Stories ............ j ......... Dimensions of shine stmcturaiwith alterations or additions: Front .................................. 10. DateofPurchase '" ............................. Depth Zone or use dtstrtct m wtdch p:remises ara situatod ....... f I otmer Owner ............................ 12. . ................... . ................... Does proposed Construction vi0 ate any zoning law, ordinan'ce or regular on ~ . . ~ ~.. 13. ~fillotberegraded ....... ~O ......... * ...... ' .............. ~ '' 14. t~ame of Owner of premises : ..... ;. ~m ex?~s fiji b%~e~oved from premises: Yes Name of Architect ..... ;~ '. N~= of Contractor ~' ~ ~2~,2' 5'W';; '~' Address ...... ~5 .' ........... Phone No . ~ . ,,xz yes, Southold '.Town T--=~-~ n .... ---7~' =xes ........ No~. ' ...... .... PLOT DIAG 1~ Locate clearly and distinctly MI buildings,'~Obeth~r existing or proposed, and, indicate all set-back dimensiofls from ,,c..,v~Ny Hnes. Give street and block number or description according to deed, and show street n~es and indicate whether '" or or corner lot. ;) 765-I FOLLOV 1. FOUl FOR i 2. ROUi 3. 4. FIN,~ PP, ROVED . 'flOTED "-.2. BUILDING OE~ 12 9 AM TO 4. ~ FOR THE lING INSPECTIONS: IDATION ~- llNO REQUIRED ~OIJRED CONCRETE ;H - FP./[MING & PLUMBING -AT, ON ,. ,, CONSTRUCTION MUST )MPI~ETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUiREMENT~ OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOr RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 'oum'¥ · '~'6)>w''' "~'~" '~' -~.~ ... being duly SWorn, deposes and says that he is the applicant t me ofindiv/dualsigning contract) ..... ~ove named. · JS tile ~ .. .................. , ........ . .... . said Owner or Owners, and is duly , . ~ (Contract corporate officer, etc.) ............... . 'm!bor~zed to P~r bare performed tile sakt work and to make ,and file this plicafion; that afl statements contained ~] this application are true to tim best of his knowledge and belief; and that the ~k will be perfo~efl in fi c manncr set 'fort ~ in the a ~ )lication fie · , 'om to before me this tl d therewith. . ..... ...... . ..... ...... : ............. Qualified n Suffolk ~u~N ~[~ . pp ) ~mmi~mn Expires Decem~& 19~.