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Home My WebLink About22808-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. N~O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .............. ~./.~ .............................. 19 '/~ 22808 Z Permission is hereby granted to: ~..,ff~....,.~.,/~,..(_~(...~ .../.(,~.,~ .......... .~.....:....~i....../..~: ........................... ........ ~.:..z~..~,. ........ 2~ ................................. ...~.,.-.~..~ .......... ...... ~ ........... .~.~.z~....~.~-~ .......... ~ ........... ...... ~ .............. ~ ...................... : ....................................... ~..~ ................................. at premises located at ................ /.,~.~,~,~.,....~....~...~......~..~ .................................. ................................................................ ~z~~ ....................................... ! ......... ~yTaxMaP No. 1000 Seoflon......~...~,.. .......... Block ......... Q~. Lot No .... ~ ...... ~ ..................... 19....~ and~" ~.,~o~,,o ~,,~o~o~ ~o,~ ............ .~~ .£. Building Inspector, Fee $....~..~.~ ...... Rev, 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197~1 TEL.: 765-1809~ Examined ., 19 .~..~.~"- Approved ., 19 .~.~Pennit No. Disapproved a/c . . , ' Bb,(R0 0F. HEALrll ......... 3 sETs OF PLANS SURVEY SEPTICCHECK ';;~/I ................' CALL * . . ' ..... FLAIL TO; APPLICATION FOR BUILDINGPERMIT 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 19cation of lot and of t~oildings on premises, relationship to adjoining premises or public sti-eets 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. 'Tbe work covered by this application may ,not be qommenced before issuance of Building Permit. . d. Upon approval of this application, the Buil~din~ Ii~sl~ector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No buliding shall be occupied or used in whole or in part for ony purpose whatever until a Certificate of Occupancy shall bare 15'een 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 Ordiuance of the T~wn of Soutlmld, Suffolk County,! New York, and otller applicable Laws, Ordinances or egulattons, for the construction of. braidings, addttmns or alterattoids, or for removal ~r demolition, as herein described. The applicant agrees to comply wi~h a!!.applicable laws, ordinances,lbuilding code, housing code, and regu ations, and to admit authorized inspect6rs on premises arid in b'uilding for necessary)nspections.. -- (Signatur~ of applicant, or name, if a corporation) - : (Mailing addr~ss~,o f .a?plicant) State whether applicant is owner, lessee, agent, architect, engineer,! general contractor, electrician, plumber or builder. ' ' APPBOV, ED AS NOTED [as on the tax roll or la~O~¥dSUILDINO ~EPARIMENT Al If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ~' 1. FOUNDATION - TWO REQU RED (Name and title of corporate officer) FOR POURED CONCRETE ;. . 2. ROUGH - FRAMING & PLUMBING Builder's License No .......................... 3. INSULATION 4. FINAL - CONSTFIUCTION MUST BE,COMPLETE ;FOR C.O, Plumber's License No ......................... ALL CONSTRUCTioN SHALL MEET .~'H~ /REQUIREMENTS OF THE N.Y. Electrician's License No ....................... STATE CONSTRUCTION & ENERGY ~ CODE.S. NOT RESPONSIBLE FOR Other Trade's License No ...................... DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done ................................. :. ................ House Number Street Couhty Tax Map No. 1000 Section ...: ........... Hamlet Block .... .L.[ ' Lot....~'.~....' ........ Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and iotended use and o~cupancy of proposed construclioni OCCUp/'t c7 . g booc ' a. Existing use and occopancy 3:t~fi ........... b. Intended use and occupancy ~.10~.~: '3. Natm'e el work (check which app icable). New Building ' . , Addition .......... Alteration .... ;.. i.. Repatr ......... ~. · · Removali .............. . Demohtion .... ; ......... Other Work .~'~.tq.OS..*.~.e.~.q 4. Estimated Cost .... ' Fee (to be pard' on fihng' thru' apphcahon)' ' ' Ifd u 'u ' fd ' ' 5. welling, mlmber of dwelling nits ............... . N tuber o welhng units on each floor... .............. · If garage, number of cars ..... i ................................................................... 6. If business commercial or mixed occupancy, specify nature and extent of.each type of use 7 .... if auy Front Rear Depth Di nenslons et existing stmctureL , lleight' Nmnibet bf Stories ' ' ' ' D ..... ~ It rations or additions: F unensmns of same stmctur~e with a e rent ................. Rear ................ D pth ~ I Hight i i Nurrb fStoies ' ' 8 Dimensions of entire uew construction: Front . Rear Depth Height Num;ber of Stories 9. Sizeofl0t:Frout i~iii!i~iil.! .... ..... :.. Rear .............: ........Depth ..................... 10. Date of Purchase .i ......... . ....... '.. Name of Fonner Owner .~t~8'. &L~fik ~ Bf~vz. bos}q 11. Zone or use &strict in wlncir pre,mines are mtuate ................................................. 12. Does proposed construction viol te any zoning law, ordinance or regulation: .......................... · .... 13. Will lot be regraded .. bl.0.. '.. ! ................... Will excess fill be removed froln premises: Yes 14. Ne,ne of Owner of premises ~O..~¢.~. ~. ~tyf~.~..g...t{~Mr4Address ~>0 SOX ~5...~y/r. 6tl~t~[' p lone No..~.3..~[7~.(3.~.:...' Name of Architect .......... i ................. Address ................... Phone No ........... : ..... Nmne of Contractor ~ Address Phone No ' 15.' 19 this property within ~00 feet of a tidal wetland? *Yes ........ No.~. ...... ail yes, Southold T. own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ,all buildings, ~'hetber existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block umber or description according to deed, and show street names and indicate, whether interior or comer lot. ~u~et V V(Name of individual si~aifig coutmct) ' ' ' above named. ' Itc is the . .:.... .............. ~.~ ~( ..... . ........................................ . .............. ~ (Contractor, agent, cor' ) ~ porate officer, etc. of said owner or owners$~ is duly[ aothorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contaihed fi~ this application are {rue t~ the best of bis ~owledge and belief; and that the work will be perfomed in the m~ner~set forth in the application filed therewith. ' Sworu to before me this : ............ or. , ...... .... , 5 Notary Public, · ...... ~. . . ,~ .~ Coun ' ., F-t.~_~?~I'H ANff N ~Vfl.k~ (Signature of applicant) · ~ot~¥ ~?~ie, St~o of Nzw York . mo. ~-Ul 2~5850, guff~lk Co~ ' ~ ' Term Expires October 3~, 1 ~,