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Home My WebLink About22847-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT '~OWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.~ 22847 Z Coun~yTaxMap No. 1000 Section ...... Z~..J~..... Block .......... .~... ......... , Lot No. .... .~... ................... pursuon, to opp,,oa,,on dated ................. Building Inspector. Rev, 6/30/80 FIELD INSPECTION REPORT DATE FOUNDATION (IST) FOUNDATION (2ND) ROUGH FRAHE & PLUFIBING COI~IEI~S STATE ENERGY CODE ADDITIONAL COI~Xil~NTS: ( YOUNG 8 YOUNG FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ......... r./...~., 19 ~'.z Permit No . ~/3B~),(RD Of' HEALTH ~w~ ......... -~c~Ec~ ........... ., SEPTIC FORN ............. CALL ................ NAIL TO: Disapproved' a/ ' \ o Insp ·" .ICATION FOR BUILDING'PERMIT ' // · '-~ 6/ ' Ddt,e, ............... .19... ,iNSTRU~TiO~N~ ' , / a, 'Tkis 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 showh~g'locatlon of lot and of buildings on premises, relationship to adjoining premises or pub/~c sfi'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. The work covered by tbJs 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 buiIding 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 Peimfit pursuant to the Building Zone Ordinance of the Town .of Southbld, 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, building c. Ode, housing code, an~ regulations, and to admit authorized inspectors on premises and in building for necessary inspe~o,ns. ~ /~ ' I , , ~ . (Sign~ur9 of applicant '~n-l'~e, if a corporation) · , (~iling address of applicant) State $,hether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician;~ plumber or builder. ~,1 ', ~(as on the tax roll or latest deed) If applicant is~ corporation, signatuYe of duly authorized officer.' (Nirne and title of corporate officer) Builder's License No .......................... Plumber's License N0 ....... ' . Electric'an s L cense NO ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................ . ................. ..Tf/. 5 . . .........- .... : ....... House Number Street Hamlet Co,,nt 000 Seat,on ...:.l.O..0..... ..... Bloc,... ........ :... .............. Subdivision ' Filed Map No. Lot (Name) , . 2; State existing use and occupancy of premises and intended use and occupancy of proposed construction~ · a. Existing use and occupancy &,,~.r~.,~r...~...C ~) : , b. Intended use and occupancy ...... ~ .... .... .V.t4 k, ~,)~ ,3~Jg~3q Vh;~O~ 3 N of work (check which applicabl ): N Building ' ~.dditi . .' ' · Rature · e ew ' · ......... on .... Alteration - epair .............. Removal ............ Demolition ......... . .' ...... : .......... Other Work ............... 4. Estimated Cost . (Description) (to be paid on filing this application) 5 If dwelling number of dwelling units ' Nu~hber of dwelling units on each · If garage n'umberofcars ~ ................ ' ................ 6. If business, commercial or mi.x~d occupancy, specify nature ar~0 extent of.each type of use ......... 7. Dimensions of ,existing structu~es, ifanv. Front -.~-O~- ]/' ~ ?,-,/, ~! ~, - ;, ,,/2, Zi/tr' ,. ..v,~,, ...~ ........... mumber of Stories /.. ' .............. ~Dim.e, nsl°ns~f,t._S~_e~Jructure with alterations %r,adaltions Front . 2, O. 77. ~./f. Re,'~ ' 8. Dimensions ol'entlre new construction. F,-,-* ~20 ~' g ,- ~ . ,-' .......... Name of Former Owner (.r..~.a ~.t'.~...](.~. I 1. Zone or use district in which pr~rnises are situated ................... 12. ocs proposed construction wo.late any zoning law, ordinance or regulation: ... ,~.. O. ............ ' x, .... ~ ,-, ~ ' . t~,4i~b',~ 7 ~ ....... Will e.x,?ss 1 be removed from vremises: wo Name of Contractor ........ ................. Address ............. . ...... Phone No ............ '. 1.5.' I.e this propert:y within g00 feet: of a t:±dal ~wet:land? ~Yes ........ (~ " ~If yes, Sour:hold Town Trust:ecs Perra:[t: may be required. ' ....... PLOT DIAGRAM Locate clearly and distinctly all: buildings, Whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description a~cording to deed, and show street names and indicate whether /'ATE OF NEW YDI?,K. , ......... . ..... being duly sworn, depose~ ~d says that he is the applicant (Name of individual signiffg contract) ' ' )ova named· .,,~. ' ~ (Contractor, agent, corporate officer, etc.) ' sa~d owner or owners, ~d is duly ~aut~o~zed to perfom or have perfomed the said work and to m~e and file this plication; that all statements contained ~ this'app ication are t'rue to the best of his knowledge and belief; and that the ~rk will be perfo~ed in the m~ner Set forth in the applicatidn filed therewith. eom to before me this I N~ARY PUBUCdSt?e of N~, ' .... ~ ..... ~,'*' · ' ~ ,-~ ....' ~. 472~9, Suffolk Coup.. . ' . · ~ature of applic~t) . Term ~iree May 31.19~ ' r