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Home My WebLink About23018-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HA~ $OUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE'IION OF THE t~,ORK AUTHOR.~ 23018 Z ~t~, ............ "~" '~"~~':_._.~..~. ............ ...L~'.~~ ~..~...z~....:.. ,o...~i i. ii~'.'ii'iiiii~.'.'."ii~,~......~~ ............... ..... ........................................................................................ ..; ................ ; . . . . . . ; ~. . . ; ............ ~. . . . ~~j~ ~ . ~ ~ .................... o prem ses I~Q G ............. /,,, ,Y,..~ ......... /M..~~,,,~~: ..................... Building Insp~tor. Rev. 6130180 N ( VACANT ) N/O/F JAMES I~ (~RR TTAN 70° 45' 10" E HUMMEL I42.00' ( LUMBER YARD ) FOR ^~:~v ^,~ ac CO.ST.UC~'K~. Outv SUR VE Y OF PROPER T Y A T SOUTHOLD TOWN OF SOUTHOLD The Io~etione of wella and ~eeepoole ehown hereon are from field obeervet~one ~nd or from data obtained from othere. · ~REA= 28,'rt00 sq. ft. SUFFOLK COUNTY, N. 1000 - 63- 02 16.1 Scale I" = 30' Dec. 2, 1987 April 12. 199?(revise lot} April 19, 1994 (foundation) Sept. 20, 1994 (final) 87- 886 B FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN HALL TEL.: 765-1802 Approved . rmlt No ............ Disapproved a/c ...................... ItbtlRD OF IlEAL. TI1 3 sETs OF PLANS SURVEY CIIECK ......... ~ ...... SEPTIC FORH CALL HAlL TO: .ICA/ION FOB BUILDING PEBMIT Date....~..~'..~.."f ........ INSTRUCTIONS ,a. Tiffs apl~lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, v, set.s 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 si or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this; cation. c. The work covered by rids application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such p, shall be kept on the premises aYailable for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any pnrpose whatever until a Certificate of OccuF shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinan[ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desc[ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, al admit authorized inspectors on premises and in building for necessary inspecti?9~.~..~, .- ..~ //) ,, .~.~7 (Sioh~t.ure of applicant,/~ na~e, if a corporation) (Mailing addre'ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui (as on the tax roll or tatest deed) If applicant is a corporation, signature of duly authoriPed officer. Builder's License No. ~ ""'--' ~ Plumber's License No ...... , JTHOL.~ Electrician's License No ....................... Other Trade's License No ...................... Location of land on which.proposed work w I be done .......... .... ......... ltouseNumber' ' . Street . Itanet Connty Tax Map No. 1000 Section ...:gl.~. ......... Block ..~.. ' Lot./(,./ ...... Subdivision ........ . ............................. '. Filed Map No ............... Lot ............ (Name) Stat~ existing use and occupgncy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy .. l.. .'?./~. ~.'.~ .( .'~. ........... b. Intended use and occupancy ...... ~ ~.5~.~ ...... ' ........................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....... Repair .............. Removal ........... Demolition ' . Other Work .~.¢ Nd ,~. 4. Estimated Cost .*' ......... ' .................. Fee ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor .............. · If garage, number of cars ...................................................................... 6. If business, commercial or mi.xed occupancy, specify nature and extent of each type of use ............... ,... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... Dimensions of shine structure with alterations or additions: Front ................. Rear ................ Depth .... ~ .................. Height ................... ;.. Number of Stories ........... i ........ 8. Dimensions of entire new construclion: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ....................... ~ ............................ 9. Size of lot: Front ......... .. ............ Rear ...................... Depth .................... 10. Date of Purchase ............................. Name of Former Owner ........................... 11. Zone or use district in which premises are situated ....... ................ '. ~ .. ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will 10t be regraded ....... : .................... Will excess fill be r~¥oved from premises: Yes 14. Nane of Owner of premises ........... ,..., .... Address .......... ;- ·a!aglla' . ~_Pla~c~,..__e No ............ ;. Name of Architect ........................... Address .~'.."Plibh~ No ............... Nane of Contractor .......................... Address ......... 4' i.. ...... Phone No .............. Is this property within 300 feet of a tidal wetland? *Ye$~ ..... No ......... '~ *If yes, Southold Town Trustees Permit may be requir~d~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back din~ensions fro, property lines. Give street and block number or description according to deed, and show street names and indicate whetN interior or corner lot. 15, STATE OF NEW YORK, S.S COUNTY OF ................. ......... ..~ .~.e~44.'~-..... ~..4~.]..~./.~.~..~..O ..... being duly sworn, deposes and says that he is the applican (Name of individual signing con tract) tbove named. ................................... . ...... te is tire .....· ................................. (Contractor, agent, cor'porate officer, etc.) ~f said owner or owners, and is duly attthorized to perform or have performed the said work and to make and file thJ q~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that tlr ~ork will be performed in tke manner set forth in the application flied therewith. 1wom to before me this ...... 1 ....... '...day LINDA J. CGOPER Notary Public. State Of New Yod~-%, No. 4822563. Suffolk Count¥C,/j~, ~rm Expires December 3~,