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Home My WebLink About22976-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. N.o 22976 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEllON OF THE VCDRK AUTHORIZED) Do,e ............. ............................... / Count/Tax Map No. 1000 Section .,.,,,,~,.2 ........... Block .....,.~2.~... ............ Lot No ...... ~,~.~fL',.,,~.~,,,,, pursuant ,o app,[¢at,on dined ......... ~.. ~.L4:./..--'......~.....~.....~. ~ ...... 19......?.~.. and app,oved bV the Building Inspector. F~ $....~.~ ..... Inspector Rev, 6/30/80 ~:' The locdlons of wells cnd cesspools hereon are f~om [/eM observalloas and or [tom dafa obfa/ned from ofhor~. AREA = 15,63c ~OR~ NO, 1 TOWN OF SOUTIIOLD BUILDING DEPAR'f M ENT. TOWN IIALL SOUTIIOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF IIEALT11 ....... -3 SE~$ ?F PL.,NS ....... /SURVEY ./'CHECK ................. SEPTIC FORtl ........... APPLICATION FOP, BUILDING PEP,MIT CALl ............ [)ate ................... 19. INSTRUCTIONS a. This applicatioll must be complelely filled in by typewriler or in ink and submitted to lhe Building Inspector, wit ,sets of plaus, accurate plot plan to scale. Fee according to scbedtde. b. Plot plan showing locatiop of lot and of buiklings on premises, ~elationship ~o adjoining premises or public stie 'or areas, and giving a detailed descriplion of layout o[ property must be drawn on the diagram wbich is part of this ap c. The wink covered by lifts nppllcation may not be commenced before i~st~m~ce of Building P~rmit. d. Upon approvM or {his application, {he Building Inspector will i~sued ~ Building Permit to ll~e applicanL Such per~ shall be kept on the premises available for inspection lhroughout the work. e. No building shall be occupied or used in whole or in part for a,y purpose whatever until a Certificate of Occupm shall have been granted by lhe Building Inspector. API'LICATION IS IlEREBY MADE to the Building Department for the issuance of a Building Permit pursuant lo Buihlhlg Zone Ordinance of the Town of Soutb01d, Suffolk County, New York, and other applicable Laws. Ordlnance~ Regulations, for [he construction of buildings, additions or alle~ations, or for removal or demolition, as herein describ 'I'l~e applicant agrees to colnpty wltb all ~ppticable laws, ordh~ances, ~hilfling code,/~o~slng code. told regulatim~s, and admit a ,dtorized nspectors o,, premises a,,d n building for *e6e,sary i ,s,ect o s ~ ,' ,, O~'-- (Si~nat[ue of applicant, or name, if a coH~orado~/) (Mailing address of applicant) State whether applicant is owner, lessee, agent, mcbltect, englneer, generaJ contractor, electrician, plumber ot buikl (as on the tax roll or latest deed) If applica,t is a ctupomtion, slgnalule of duly authorized officer. (Name and title of corpo;ale o[ticer) Bt ihle~ s License No .......................... I It bel s License No ......................... Elecl icia ~ s License No ....................... Other 'liade's License No ...................... Location of laud on which proposed xvork will be done ............................................... · .t. t .c-. ............ b.o..to[ ............................. I louse Number Sheet llamlet Cou,,ty Tax Map No. 1000 Sectlon .... 'b.~ .......... Block ~ ' Lot'--'q f4, 1 3 Filed Map No. Lot Subdivisior~ ........ . ........................................................ (Name) SlateexislJng ~se~ d occupancy of premises and inlended use and occupancy of proposed construclion: a. Exisling use and occupancy ~ ...... -., ,~- =, ~., ~ ....................... & ~ k, ~ ,D_,ok~. Y~'-~TC~ ........... ............................ ~. ,.Ig.~ ~.~ ~ ............ 3. Ndture o[ woik (check which applicable): New Building .......... Addition .......... Alierati~ . . .~:~ .~,, . Repair .............. Removal .............. Demolition ..... ; ......... Other Work. ~.~. 4. ~sli/llaled Cost ~ O ~ Fee ' ' (to be paid on filing this application) 5. If dwelli~tg, number DC dwelting units ............... Number of dwelling units on each floor ................ . 11~garage} number of cars 6. If business, commercial or mijed occupallcy, specify nature and extent of.each type of use ..................... 7. Dimensions of existing st~xmture.~, if any: Front ............... Rear ............. : Depth ............... }leight ............... Nmnber of Stories ........................................................ Dimensions of same sh'uctu*a wfib alterations o~ mhfifions: F~ont ................. Rear .................. [)cplh ...................... lleigbt ........... ' ........ :.. Number of Stmies ...................... 8. Dimensions of entire new construction: Frout .............. ; Rear ............... Depth ............... Ileight ............... Number of Stories ........................................................ Size of lot: Flont ......... : ............ Rear ...................... Depth ...................... Date of Purchase ............................. Name of Fo~qner Owner ............................. Zone or use district in which premises are situated ..................................................... l)oes proposed colls(rtlctioll Violate [[11~ zoliillg law, ordiua~tce or [egulation: ................................ Will lot be regraded ....... ', .................... Will excess fill be removed from premises: Yes Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Pbom~ ~o ................ Name of Contractor . ......................... Address ................... Pholle No ................ l~ c[tls property w[Llt~tx 300 feet of a C~da[ ~qetland? ~Yes ........ No ......... *If yes, Soukhold Towel Trustees Permit may be required. P LOT D I AG RAM L~cate clearly and dJsfinctly all buildings, xvhetber existing or proposed, and. indicate ali set-back dimensions from property lines. G~ve street and block number or description according ~o deed, and show street names and indicate whelher interior or corner lot. _NOTIFY BUILDING DEPARTMEN'r AT 765-1802 9 AM TO 4 PM FOR THE FOLLO'v'V~NG INSPECIlONS: 1, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE '2. ROUGH - FRAMING & PLUM~ING 3. INSULATION 4. FINAL - CONSTRUCTION MUST RE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL NIEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUGT~ON ERROR~ ;TA'Ft~ OF NEW yOl~5:~i/ S S ;OUNTY OF ...... ~.%~ ..... /' (Name of imlJvidual signing conh act) ~tbe .................................. ....................................................... (Conlraclor, agent, CO[l)o~ate of~iceL etc.) said owner or owners, ami is duly authorized to perform or have performed the said work and to make and file this 9pl~ca[ion; that till statements contained in lifts application are true to tke best of his knowledge and belief; ami that the ,o[k will be pe[[ormed in the m~et forth in the application filed tbe[eWfib, worn to before me this ~ ~ 8~ ~C, ~t~l~l ~,~.' ..................................... No. 4~9, Suffolk ~u~, (Signature of applicaat)