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Home My WebLink About22750-zFORM NO.3. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 22750 Z BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ....... ~.~... .....BLock ........ ~ ........... LotNo..~. ...................... p,r$,on,,o ~pp,oo,lon dot~ ................. ~..~!.._:~ ......... ~.~. and °,,roved byth~ Building Inspector. Fee $...~.. ~.. Rev. 6130180 Building I FORM NO. 3 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTtIOLD, N,Y, NOTICE OF DISAPPROVAL · ..~..~~./,.~.%.~...,,~.~× , _ PLEASE TAKE NOT ~ --/ - ICE that your application dates ...~d/~..~. .................. 19 ~.. Location of Property ..~: ...... ~..~~ ~ ~.. County Tax MapNo. 1000 Section ...~ ....... Block .... ~.~...Lot ..~d ........ Subdivision ................. Filed Map No ................. Lot No .................. is returned Cerewith and disapproved on the following grounds . ..%-*: .. _., , · ~~..~*~:.~.,z.~ ..... ~. ~ ~ .~ ..... (_. ~ ~ ~ · ' ........... L"~ .... ~ ....... ~ ......... .............. ~~ .... ~. ~ ...................... RV 1/80 lill~l .,,-- ~llll TOWN OF SOUTHOLD SU~t,'~Y .................. fiji[ [W'2'7 [~ fL}L} BUILDING ~EPARTMENT ClIEC~ ......... ~ ......... ~~ / ~'~,..: ~ .... ., s~T~c ~o~ ............. ~ BLDG DEPT. ~ SOUTh~.~', N.~. 11971 ~ TOWN OF~OUTHOLD TEL · 765-1802 ' t¢O?[ F~ = . - -/ ~"~ - ~ " ' c~ 2b~z~3.Q~: ...... .. ................... -' ~PPklC~ FOB BHIkDI~G'Pfi~MII' ~ . ~ ~ .....~ .... , ~% INSTRUCTIONS a. This application must be completely filled in by Wpewr/ter 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 st'feets , 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 issued a Building Permit to the applicaht. 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 e~6~i~ly with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized ins, pectors o~ premises and in building for necessary insp~ -- (Si or oration) (Mailing address of applicant) State wl~ether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a c~[~f-g~.ure, ofiduly outhorized officer. (Name al~d title of corporate officer) Builder's License No .......................... Plumber s Lmense No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be 'done .................... ' ...... ...~..~5 .......... '. ~. ~?.. ~ ~. :?.~..,~...¢.,,,~. ............ ?.5.,,. ~.o.~.~....' ....... . .... ltouse Number Street Hamlet cotmty Tax Map No. 1000 Section ... :.~.~ ........ Block :...0.5 .......... Lot....~(:~ ........... Subdivision ..... [(~;}./.IO. laJ. ~.O} .~. ' Filed Map No ........... Lot (Name) Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: · 3. Nature o work (check whzch a,Pphcable): New Building .......... ,~ddition .......... Alterati~.g ........... Repair ............. RenJoval .............. Demolition .... : ......... Other Work ~II~.~T,, ~-~ 4. Estimated Cost ~ ............. Fee (to be paid on filing this application) 5. If dwelling, number of dweltin~ units ............... Number ofdweliing units on each floor ................ If garage number of cars i ' 6 ' If busine'ss .................................................................... ' .... · , commercial or mi,x~d 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 .................. 8. menmons or e,,,~t[~e new construction: Front . ..£~ .~,~... ~ Rear ..... . .--~'.'.'.'.'.'.%~.. ...... Depth .. 7..~..: ....... .Height ...~ ...... ~u_rg.l~r_of Stories .; ................ ,, ....................... I 1. [ lcr ~n wmcn premmes are mtuated ................................................ . ..... ,12· Does proposed construction violate any zoning law ordinahce or regulation· . 14. N ' ~ g ' '" ' ' '> 'i ....... ~. ·..,.,. Will excess fill be removed from premises: Yes No Name of Architect .......... ~ ................. Address ................... Phone No ................. Name of Contractor ......... I ................. Address ................... Phone No ................ 15.' I~ this ~roperty within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes,'Southold ~own Trustees Permit may be required. i PLOT DIAGRAM 7'. Locate clearly and distinctly all ibuildings, Whether existing or proposed, and, indicate all set-back d~nensions from property tines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. . . -- NOTIFY .BUILDING DE~ 765-1802 9 AM TO 4 PM FOR THE ,. FOLLOWING INSPECTIONS:. 1. FOUNDATION - TWO REQUIRED '~' FOR POURED CONCRETE '~ '2. ROUGH - FRAMING & pLUMBING 3. INSULATION · 4. FINAL CONSTRUCTION.MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION ~I,{AIJ,, MEET THE REQUIREMENT~ OF '[R~ N.Y. STATE CONSTRUCI~N CODES. NOr RE~RBN$111~ I~OR ' ' ' '~9/~"~a mr' ~'f in ~iv' ~ '~'~'~,///(g~2~'~,[ ....' ........ being duly sworn, deposes and says that he is the applicant Lt]~ g~0 iaua~sigmng contract) above nam efZ/ L/ i He is the ' (Contrhctor agent corporate officer etc) ' of smd owner or owners, and m duly ~uthorized,to perform or have performed the ,said work and to make and file this application i that all statements contained in this Application are/rue to the best of hm knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. ' Sworn to before me thisr Notary Publi . County . ' CLAIRELGLEW' ~. . , " No. 4879505 .... . (~oMified iA Suffolk .Cotm~p .. ~/'.~ ' pi , LOT 4 /OT$ (¥4 c ,s/~r)