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Home My WebLink About22779-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) z ~'~ ......... ~~"/"~ ................... Permission Is hereby granted to: I -- ~ ! . .~..~ ./.....~...... ~(Z~.~ ....... C ......... ~..~...x..~..c~......~.~.... , ,o.....~.~....~ .......... ~...'...~a ...... ~....~..../..~..~..~../.~ ......... /~,...z~.....~~~.......,~.. ....... ~/.../,..~J~.: .... c~C /I/~ . ................................................... ~...~./..~..~c& ................................................. CountyTax Map No. 1000 Section ........ .,.~.,....~...?.... Block ......... ./. .............. I~ot No. ...3..{ ................ p~suon,,o~pp,,=t,o~do,ed ..................... /0._~.~...~..... 1,....9'.~. cod opp~oved ~y,he Building Inspector. ~ee ~...,~...~... Rev. 6/80/80 FENCES CORP~ 1760 ROUTE 25 · P.O. BOX 430 · RIDGE, NEW YORK (~ ~T' I-~~F~ ~_~E~D ~--' TELEPHONE516-924-3011 Sold To: ~:::>~ r~ ~ ~ ~ Address: '~c~i~ '~r~ City/State: I,~A-Vc;-i--t~ V-; Res. Phone: ( ~'1~ ) Bus. Phone: ( ~ ) Erect At: ,, ......... ..., ,~__g,.; On Or AboUt~ Weather Permitting. Front In iD Sides In iD Back In iD ~ OM O U t ' 'iNITt. J~ LL REMAIN THE PROPERTY OF THE SELLER UNTIL iT ~ E FENCE MATERIAL SHA O TO THE PROPERTY, ~Hp A t D FOR IN FULL, NO MATTER HOW iT IS AFFIXE FENCE Ht~IGHT,~D LOCATION IS THE SOLE REBPONBIBILITY OF Purchaser ._ Date: ~ ~' "AFC Representative: _~ .~__F~'.- Straight On Top E~ Clearing By Owner FOOTAGE WRII-I'EH ON TH~S C~ ~ ABOVE E RE FOOTAGE TO BE CHARGED AT UNIT pRICES. ANY CNANGE~E ~DE OF THIS CONTRACT ARE Contract Total $ i.__/:~e',._~o 0 Deposit $ ~'6,0 ~ ~- Setting of Post $ On Comeletlon $ --~'~ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 765-1803 Disapproved a/c ' ....... ~ I~;~;~t · APP~ATION FOR BUILDING'PERMIT ' Date ................ INSTRUCTIONS a. This application must be completely filled in by typewriter 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?eets or areas, and giving a detailed description of layout of property mu~t 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 i~sued a Building Permit to the applicant. 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 South6ld, 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, 1)x(flding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~/-~ A I l~. r~ f~ h , --' ' (Signature of applicant, or nfi~e, if a corpgration) .... ~~/' ' aili addre~,olq~l~can[(~ ) tS' -~ State whether applicant i~essee, agent, architect, engineer, gqne,ra! contrhctor, electrician, plumber or builder. '' i Nameofownerofpremises ~r~-4,.~ CZ)-. .~.c/~.../~..~...~..!.~.:.'.'~. ~ (as on the tax roll 6r latest deed If applicant is a corporation, signature of duly authorized officer. CALL rOpo (Name and title of corporate officer) Builder's License No ....................... Plumber's License No ..... Electrician's License No... Other Trade's License No... .................... 1. Location of land on which proposed work will be done. House Number Street Hamlet Cou'nty Tax Map No. 1000 Section . ~.: ............. Block .... ] ' Lot. ~ } Subdivision..: ..... . ............................. '. Filed Map No ............... Lot ' ' .. (Name) 2: Stat~ existing use and occupancy of premises and inten:ded use a~l~tccup~ypf propose~ constructioni a. Existing use and occupancy ............ ~ ......... .. , ..................... b. Intended use and occupancy ................................... ~..%... ;,.. ~}. ..................... .,Ig C · 3. Nature of work (check which a ~plicable): New Building . ~ ........ Addition .......... Alterat~o~ . Repair .............. Re, oval .............. . Demolition .~..,. ....... Other Work..LC.. "~ [ I O ~ ...... ; ~J~escnption) 4 Estimated Cost , Fee (to be paid on filing this application) 5. ![ dwelling, number of dwelhn~ units .............. ,,. Number 6f dwelling units on each floor .... /; ......... l! garage, number of cars .... i ......................... ,~-..' ......... ~'.... AoX. ~. ': .... .... 6. If business, co~nmerciai or mi.x~d occupancy, specify naturq a~l~fftent of~e of,v4el ~..a...'. .......... 7. Dimensions ol existing structures if anY' Front- -- /'2..q''' ,~,~e'~/' " Ii) '~-,~, ' ' Height ............... Number of Sto. ries /~)~~'~: ~5~: .................... · Dimensions of shine structure with~alt~ralions or a~.Fron~ ~.~..,~__.:. ~. ..... Rear ............ ' Depth...' ...... !,-'/~5i~t . ~'~'~.'q~,~'~ ' . ' ' ' ............ ~~ w' .~am'oer o! ~tones .................. 8. Dimensions of entire r~vw/f'~rl'~t)ction:~W~..~., tx.. ~J~f~ ....... ~ ..... '-' -- ' " .Height .......... !.ff~..k"Numjp.~Stj~.~..~ ....... I,)...~..: ................. 9. Sizeoflot' Front ~]i"i"."~);&;~ ..................... ...... 3..~'~~ .... ; ...... .Depth ................... 10. Date of Purchas~ormer Owner ... ~ ...................... 11. Zone or use ~~ . .' .......................... ''. .12. Does propo vioiate any zoning law, ordinance or regulation: ........ ....................... 13. Will lot be regraded ....... "i ................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' Address Phone No of Architect i Address Phone No N ~' ' Add ' Ph ~ No ' amc of Contractor .............. , .......... ress..., ............... on .............. 15. Is. this property within ~00 feet of a tidal wetland? *Yes ........ No ......... · If yes,'Southold ~own Trustees Permit may..be required. PLOT DIAGRAM Locate clearly and distinctly all! buildings, Whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. FOLLOWING iNSPECTiONS: 1. FOUNDATION ~ '~IO . 'FOR POURED CO~CRETE 2~R OUGH - FRAMING & PLU~V~ING 4. FiNA~ CONSTRUCTIO~ MUST ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE ST~FE CONSTRUCTION &' ENERGY CODEs. NOT RESPONSIBLE FOR DESIGN OR CONSTRucTIoN ERRORS STATE OF ~EW YORK,G . COUNTY OF. t.<,. .... S.s ................ ' being duly sworn, deposes and says that h ' ' ........................... . e Is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly autl3onzed to perform or have performed the said work and to make and file this application; that all statements contained in this'application are true tO the b. est of his knowledge and belief; and that the work will be performed in the manneriset forth in the application filed therewith. ' Sworn to before me this l ................. /..day of ~ ./,v. .... ...... NOTARY PUBLIC, S*at~ ~{ Naw y~I'I~ (Signature of applicant) No. 52 · 4~614~ Qualified In SuffOlk C~nty^ .0