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Home My WebLink About22749-zFORM NO.3 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUIHOLD, N.Y. 22749 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Couniy Tax Map No. 1000 Section ........ .~..¢ ......BJock ............ to application dated ................. ~,...J,..~......, 19../.~....~...., and approved bythe pursuant Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN tlALL SOUTtlOLD, N,Y. 11971 Disapproved a/c .................. i .... (Bufldmo h p ;ATION FOR BUILDING PERMIT · II4STRUCTIONS BOARD OF IIEALTII 3 SETS OF PLA;~S ., SURVEY CIICCK ............... . SEFTIC FORH CALL HAIL ~0; a. This application must be completely filled in by typewriter or in ink and snbiuitted to the Building Inspector, with 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'eet. or areas, and g.i'dng a de~ailed description of layout of property must be drawn on the diagram which is part of this appli cation. , c. The Clerk covered by this application may not be comme~nced before issuance of Building Permit.~ - d. Upon ~proval of tills application, the Butldlzag Inspector will ig,~ttad a Btltlding Purmit to the appllcnl}t. sh~ be kept on the premises available for inspection throughout the wor~. - e. No bai}difig shall be occupied or used in whole or in p~t for any purpose whatever until a Ceaificate of Occupm:cy sh~ll have been' granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Bulldog Dep~tment for the issuance of a Building Pe~it pu~u~nt to Building Zone Ordinance of the Town of Southold, .Suffolk County, New York, ~d other app~cable ~ws, Ordin=ces or Regulations, for the construction of.bu~d~gs, additions or alterations, or for removal or demolition, as here~ described. The appficant agrees to comply with all appficable taws, ordinances, bufldMg code, housing code, and regulations, and to admit authorized Mspecto~ on premises and M buildMg for necessa~ inspections. (Signature of applicant, or name, if a corporation) bvx.. t ...... (Mailing address of applicant) State whether applicant is owner, lessee,~ architect, engineer, general contractor, electrician, plumber or builder. N~ne of owner of premises .. ['-{~ rl(a;~ gq ,~.. . .~ .E~) ' . ................. .. (~on the tax roll or latest deed) If ...... applicant~ ~~.~..F~...i a corporati n,,signatufe of duly ........... authorized officer. · . ' (Name and ~ of c~rporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other rrade's License No .... Q ~., .5..~'.~.'.-.. 1, Location of land on which proposed work will be done ......................... ; ............... ......... · cZ ..... '.: ltouse Number Street Hamlet / County Tax MapNo. 1000 Section :~..i...~ ....... & .......... .... .... ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... · ................................ ",~,endeduseandocc~pancy .~' ' ' .~ · , -t. "t':'" ~' '3. Nature of work (check which applicable'. New Build' Repair .......... R~mov-' )' mg .......... Addition .......... AheratJon ........ ' - a~ .............. Demolition .... : ......... Other Work ,~.~J'K'.~ ,"Ii ~ .... ~4! ', Description) 4. Estimated Cost ........ ! ' Fee. .................. 5 f dwelling, number o{'dwc l rig un ts I ' (to be paid on filing this application) If., . ,,,~.,.. ~r_ . · ............ Number ofd~vclbng u: ts on C If [OOr a. ~c ~.~i,,~, ~on,~=. ~ o~]2Z', .............. ; ..................... ................ ' ....... 7. Dunens~ons of existin- stmetn'-~ '~ . ~ ~ type of use ............... Dimensions (ffshme structure With alterations or additions: Front ' Depth ' i ,, · ......... Rear 8. ' .............. lie , it ............ Dmie~siolsofe-*: ............ ~ .. g "';,'t~ .... ~ ..... ;..Numberers eries.. . ' ' ''' t, , , e t'J'~u~Csv~l~S~FHC[ O11: Front- ~ ~ ~ p,, ~z ~ "''','6'; ...... ................. :~Uqmer of Stones ................. ' ...... : ............... 9. Size of lot: Front ......... ~ ........... Rear · · ,0. ..... ' ' ..................... 'Tb ........ I. ' ............. ' ........ Name of Fornlcr Owner ............. Zone or use district in which p~emises arc situated...~.~ ................................. 2. Does proposed construction YJoJat~ any zoning Jaw, ordinan'ce or regulation: .. -~ ........ ~. ;.. ~a&~ ...'~ek Name of Architect .~ ~ ...... ~ ................. Address ................... Phone No ......... . N~e of Contractor ...~.~ ~ f ~R/~.~. Address~.~2Q N~ ~.~ I)hone No. q ....... ).. I.s th~s property w~thln ~00 feet of a tida~ wetland? ~Yas ........ No..~ ' ' ~Zf yes, Southold ~own Trustees Permit may be required. ' .... i PLOT DIAG~ Locate clearly and distinctly all~buitd~gs,'whcql'er existing or proposed, and. indicate all set-back d~ensions frbm ,perry tines. Give street ~d block ~ tuber or description accord~g to deed, and s ow street names anti indicate whether or or corner / Iit RPe~OVEI)..~ NOTED . ' ... t,~ .MT AT FOLLOWING ~NSPf: C'f'~F~NS' 1. /:OtJNDATff,.,. : ,;., 8~; COMPLEr~ ~;0~ C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.~ O~S[SL~ FO~ cl 5 ' Arelc CT: TATEOF N~RIS~,// ' / (Name of individual signing ~ontract) )ove named · ~ being duly s:vol'n, deposes and says that lie is tile applicant · . ' : ., (Contractor~orporate officer, etc.) ...................... , .s,~f_..ow,).e,r ?r .O. wners, and ,s duly. author, zed to per'or ha, e pe,'formed he said %York pNUatlOrl, I/Iai all statements COiltalnef/~ fi ie an,)l;..,; ...... ,._., ,~ ,, , .... to make and file th s / *o I') ,,~u~,uil a/g uuu to tile oegt Ol Ills knowledge and belief; and that the )rk will be effete ' P din the mannersetfort in thc applica o~ fi ed therewith. ,'om to before me thik r , } · '. ~ ..... o:, y ~ · ~WVu~llo, StateofNeWYo~ . UV~J:~. ~, I/I 4 %F ~/~ - uualifledlnSuffolkCou~. ~/ ' ' [ ~ '[ .............. ~ ...........