The URL can be used to link to this page

Home My WebLink About22829-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE Date ~..~... ................. 19 ......... 22829 Z Permlss on s hereby CountyTax Map No. 1000 Section ZZ.~... ..... Bock ~ .., LotNo .../...~. .................. 19.....~...~.' ..... and approved bythe pursuant to application dated ............. ~.~.....~ ........ '/ Building Inspector. Fee 0...?~...' ........ ~.. Rev, 6~30/80 i~xamined. Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN itALL SOUTNOLD, N,Y. 11971 TEL: 765-1802 Disapproved. ,~ ...................... (Building, In p CATION FOR BUILDING PERMIT 3 SETS OF PLANS .......... SURVEY ................... CIIEC~ ......... ..... ...... SEPTIC FORH ............ ~ /--~ / -- ~ ~.~/ HAIL TO; . Date ................... 19. INSTRUCTIONS ' a. This aPl}lication must'be completely filled in by typewriter or in ink and submitted to the Building Inspector, wili~ 3 :sets of plans, accurate plot plan to scale. Fee acco[ding to schedule, b. Plot plan showing 19cation 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 must be drawn on tbe 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 issoed a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout tbe work, e. No building shall be occupied or used in whole or iu part for any put'pose whatever nntil a Certificate' of Occupancy shall have been granted ~y the Buikling Inspector. ' APPLICATION IS ttEREBY MADE to the Buihling Department for the issuance of a Buikling Permit pursuant to the Building Zone Ordiuance of the Town of Soufimld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buiklings, additions or alterations, ar for removal ~[ demolition, as herein described. The applicant agrees to comply with all applicable law~, ordinances~ built Jug code, housing code, and regulations, and to admit authorizeS inspectors on premises and in build~g for necessa~ insp~& .--~ .~.~~~ (S~atur9 of a~ca~/or name, i~corporation) ...... ~. ~'. ..... ~.~ . . r~.l, ,1 ....... ~.~., .......... . . . State wbether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer.' (Name and title of corporate officer) Builder% License No...-~. ...................... Plmnber's License No. ~'--' ' Electrician's License No. Other '1 rode s 14cense No ...................... 1. Location of hind on which proposed work will be done ........ ' ......................... ~ ................ ...... ...... ' .............. ........... .... llouse Number Street Homier Cou'nty Tax Map No. 1000Section ....//.~ .......... Black '....2. ' Lot../~ ........... Subdivision ........ . ........................... '. Filed Map No .............. -. Lot ............... (Name) 2, Slate exisliug ~se and occup0ncy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy ............... ' ....... N,[~ ~a ~*~;~g ,O,J[~'.~< *¢¥~A~0~ .................... ' ~. Intended rise and occupancy ..................... , ..... ~ ~ '. i g ~ ~{v',' ~j~¢~ '~¢~ ...................... ~" ...... ~ ......... ........ Vt, m.,tmu); t'lcw mm0mg .......... Addition .......... Alteration .... : ..... Repair .............. Rembval ..... Demolition .....: ......... Other Wink ~/~ 'i~ ........." (Des iption) 4, Estimated Cost , ' ' , F ' (to be paid on filing this application) 5. Ir dwelling, nmnber of dwellh~g ;units .............. .. Number 0f dwelling units on each floor... .............. If garage nmnber of cars 6 ' Ir busme'ss ................................... ' ................................ · ·, · ' , caren ercmlor mixed. occupancy, specify natnro and extent of,each type o~use ,,,,.,,,..,,. 7. Dimensions of existing structures ir any: Front Rear IIeight Num'l" >er of Stories .............................. Depth ....... m , ,, Dimensions of stone stmetu e w, ~ alteratmns or add~bons: Front ................. Rear .......... l)epth ' ' lleigM ' , Number of Stories 8. new CoBstlTICIIOn: Fro, nt .............. ~ P. ear ............... Depth .............. ............... Nu~nuer- '- of Stones ., .' ..................... , .......... 9, Sizeoflot: Front .... ,~,7.:~/i ....... :,, Rem ,..¢d~P, ~ .... ..... ; ........ Depth Z] iiii ..... 10 Date of Purchase ' ............. ~ ' Name of Formm. Owner 11, Zone or use district in which premises are situated 12. Does proposed construction violaie any zoning law 13. Will 16t be regraded ....... :, .; ............. Id. Name of Owner of premises .... ; ....... :... ~. dinance o! regt let:on: " .... Will excess fill be removed from premises: Yes No Address . Phone No Name of Architect ........... i ............... Address ................... Phone No ............ : .... Name of Contractor .......... [ .............. Address ............ : ...... Phone No ................ '15.' l,s this property within 300 'f'eet of a tidal wetland? *Yes ........ ~ ....... *If yes, Southold 'folwn Trustees Permit may ~e required. ' ~ ,.. i PLOT DIAGRAM : Locate clearly and distinctly all b~ildings, whether existing or proposed, and, indicate all set-back dimensions from' property lines. Give street and block nu',mber or description according to deed, and show street names and indicate whether intm~or or corner lot, I,/ tt- STATE OF NEW Y-O~, , coum'¥ ...... s.s ........... $. , ·,. being duly swam, deposes aud says that he is the applicant (Name of individual signing coptract) ' above named. r i rp ate o e, etc. of said owoer or owners, and is duly antbDrized to perfono or have perfommd the saki work and to m~e and file this applicat,ion; that all statement~ntained u? this application are true to fi~e ~est of his kuowledge and belief; and that the work will be performed in th~naduer set forth in tim application filed therewith, Swam to before me this ~/ ' ...... No. 4725089: SuffOa Cou~ ' ~rm ~r~ May]31, 19~ ·