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Home My WebLink About22824-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT N_o (THIS PERMIT MUST BE KEPT ON THE PREM/L~S UNTIL FULL z ~'~"~ ..................................~'" ~"~ ............. ~'"~ Permission Is hereby granted t .~;~"' / - / - ............. ~.~~ .............. :.../.~...~ .... 1...o,.,,~.,~,,,., .(.~.~ ~ d' f:~2....-, ~.....~......~z..../..~.~,..z~...~.....~ ...................... ....... ...-... .......................................... Coun~yTax Map No. 1000 Section ...... .,~,,...~..~,.... Block ......... ~, ........... LotNo ....../...~,. .............. pursuant to application dated ...................... ~ ......1 g.. , and approved by the Building Inspector. Fee*,,,~.:,,,,,~ Rev. 6/30/80 Building Inspe~ MIDDLE ROAD N. 43° I~' 20" 'E. FD 9 4~' 87' 40' W - 60.00i 444'-e Z MIDDLE ROAD { NORTH #eABt. N. 43o I~,~ 20'* IE. i~0.00 FORM NO. 1 TOWN OF SOUTHOLD BUILDI?J,.rJ D.cPARTM E- NT: TOWN HALL SOUTHOLD, N.Y. 11971 Approved .~.~.~...., ... it No ...... ' DisapprovedI a/c ............. (Bmldmg Inspector) FOR BUILDING PERMIT . INSTRUCTIONS BOARD'OF HEALTH ........ 3 SETS OF PLANS ........ SURVEY ................. CHECK I. Location of land on which proposed work will be'done ......... .... '..' ..... ....... ..... ..... . .... ... . House Number Street Hamlet Co,,~tyTa~apNo. 100OS~c~io~ ...:..l'..q..O... .... ~,oc~ ..... .0...~.. , .. Lot...I.~ ............. Subdivision ................. . · .................. '. Filed Map No ..... Lot (Name) ......................... 2: Statd existing use and occupancy of premises and intended use and occupancy oF proposed construction: Existing use and occupancy ........................ . ......... ~';~,3. t~ ~.~.~ ~J: ,;~..~ .....q ..................... b. Inten~ied use and occupancy · · ........................... ame and title of corporate officer) Builder's License No ................. ' ......... Plumber's License No. Electrician's License No ....................... Other Trade's License No ...................... ' a. This application must be completely filled in by typewriter orin ink and submitted 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 l~uildings on premises, relationship to adjoining premises or public st['eet or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appL 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 applicant. Such perm/ 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 Occupanc' shall have been granted ~,y the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmer~t for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southbld, .Suffolk County, New York, and other applicable Laws. Ordinances o 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, building code, housing code, and regulations, and t( admit auth°rized inspect°rs °n premises and in building f°r necessarY~Tecti°~ . .~./..~.. ' . -. ' '. ~:~. ........ :... ....... (Marling address of apphcant) State whether applicarit is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. Name of owner of premises ." '," " (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authori:~ed officer. .3. Nature of work (check which Repair .............. Roi 4. Estimated Cost i ~ ..... , ~ ,,i (to be paid on filing this application) 5. If dwelling number of dwellin~ units" -' ,-~- - ~' ' ' ' t ' '~' ....... ' °' l'~ulllo¢l u,i/ awe Ing units oil each t]oor. . n garage, numoer cars . .. .................... . 6 Ifa ' I ' id ' "i~;n ........ h typ ....................... "" . usiness, commercia or mix occupancy, spec ature and extent of.eec e of use ..................... 7. Dimensions of existing structures if any: Front Rear ' ' Depth Height Number of Stories : Dunenstons of same structure with alterations or additions: Front ................. Rear .................. pth ' ght ' De ................... .i... He] .................. i., Number of Stories ........... ~ ......... 8. Dimensions of entire new construction: Front . .~ ....... ; Rear .............. Depth .... j ....... .Height ............... Number of Stories ......................... ~ ...................... 2. ...... 9. Size of lot Front . · '~., · ' ' ' · ,I ..................... ~/. ................... Depth ...................... 10. Date of Purchase.. ...... "' 'i .......... ' ........ " amc of Former Owner ................... l 1. Zone or use distrmt in which premises are situated .... ' ' i i i : ....... 12 D d gl di ........... ii ............................... '13' Des propose construction v ate any zonin aw, or nance or regula on: .... , ........................ ,.... · Will lot be regraded ....... :i .................... Will excess fill be rem6ved from premises: Yes No 14 Name of Owner of premises ~ Address · ' ' ~ .........~ ........ ' ' Phone No Name of Architect I ............................... ;... ......... i ........ . .......... Address ........... ........ Phone No .......... .. Name of Contractor ........ .................. Address ............ : ...... PhonevoNo.... ......... ' .... 15.' I.s this property within !300 feet of a tidal 'wetland? *Yes ........ No..,/.\ .... · If yes,'Southold iTow.n Trustees Permit may..be required. PLOT DIAGRAM . Locate clearly and distinctly ali buildings, ~heth~r existin~ or proposed and, indicate all set-back dimensions from property lines. Give street and block!number or description according to deed, and show street names and indicate Whether ~pplicable): New Building .......... Additio .......... Alteratio, a, ....... 2.. novel ........... Demolition .. .... :...n.. ..... Other Work..-~L:(~r~.C~.~... · .~. ~. j (Description) interior or corner lot. APPROVED AS NOTED pats:B.P, #_ ' FEE,* __: ~y: EmilY 81JILOING- ~p~-RTMENT A~ 765-1802 9 AM TO 4 PM FOP, THE FOLLOWING INSPECTIONS: 1. FOUNDATION, . TWO REQUIRED FOR POURED CONCRETE 2, 'BOUGH. FRAMING & PLUMBING 3. INSULATI. ON 4. FINAL CONSTRUCTION MUST BE. COMPLETE FOR C.O, ALL CONSTRUCTION SHAM. MEET 'THE REQUIREMENT~ OF, THE N.Y, STATE CONSTRUCTION & ENERGY .' CODES. NOT RE~PONSIIBLE FOR . DESIGN OR CONETRUCTION ERRORS STATE OF'NEW YIgRI(' . ~ ................... · . .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ' ' ~bove named. '-q ~Ie is the i OD. aD ~ ~ (Contractor, agent, cor'porate officer, etc.) )f said owner or owners, and is dulyI authorized to perform or have performed the said work and to make and file this ~pplication; that ali statements contai{qed in this'application are t'rue to the best of his knowledge and belief, and t ~a v * ' · . ..... t the · ork will be performed m the..~ner ~et forth in the apphcatmn filed therewith. )worn to before me this // 4Diary Public .... ~Count~/.X ~ ,' ,o , /~ NOTARY PURUC; ~' of N.Y. ~'~q~ ~ .......................... ' No. 4725089+ Spffblk. C~_._ur,c~~ . /I. (Signature o f apphcant) . Term Eq:dmS M~V 31, 19-!~Ip ,