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Home My WebLink About22922-zFORM NO.3 BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE ~VORK AUTHORIZED) Date ...................... 22922 Z Permission Is hereby granted to',. / / ,~/ ~ ~ ~ ......... ......... CountyTax Map No. 1000 Section ........... ./.,./../..,,, Block ........... ~ ....... LotNo .....~ ................... 19,,..., .~,,.~,., and approved bythe pursuant to application dated ............. ...~b......~..~...,~ ....... / Building Inspecto~¢-) Rev. 6/30/80 Building Inspect/cf FORM NO. 1 TOWN OF $OUTIIOLD BUILDING DEPARTMENT TOWN tlALL SOUTIIOLD, N.Y. 11971 g~)ARD OF IlEAL'I'll ........ 3 SETS OF SURVEY ................. SEPTIC R ...... Builder's License No .......................... Plumber's License No ......................... Electncl n s License No .... Other Trade's License No.. ~..~, ............. FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUS'If BE COMPLETE FOR C:O, ALL CONSTRUCTION SHALL MEE1; THE* REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR Location of land on which proposed work ~_vJll be (lope ..... ~. ~ ............ QESIGI~.OR. CONSTRUC)'ION. ERROR~. ·. Ilouse Number Street Hamlet ~ CotmW TaX Map. No. 1000 Section ~..: ......... Block .......... ;... Lot ...... Subdivision Filed Map No ' Lot (Name) . , , d occupancy, o reposed construclion: State ex/sling usc and occupancy or pre~ s and inl~ded usc an f p vvi.6ne nsc and occupancy .... ' ....... ~.~ ~ ............................. ~ ~ded u~e and occupancy ......... . ................... TEL 7(35' .... · ¢ , .................. Approved ...... u o ............ Disapproved a/c ' i,~, i:~ ~' '/ ,, ' ~ylCATION FOR BUILDING l'El2NllT I ,JUL £ 0 1995 D,~te .................. . I .. ' : , INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Bmldmg Inspector, w~th sets of plans, accurate plot plan to scale. Fee nccording to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public st?eel, or areas, and gl .rog a detailed description of layout of property mu~t be drawn on the diagram which is part o£ this appli- cation. c. ' The work covered by ttfis application may' not be commenced before issuance of Building Per'nit. d. Upon approval of this application, the Building Inspector will issued 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 ~rin part for any purpose whatever until a Certificate of Occupancy shall have been granted by th]~ Building Inspector. · APPLICATION IS HEREI~Y MADE to t~ Building Department for tlie issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and oilier applicable Laws, Ordinances Regulations, for thc construction or.buildings, additions or alterations, or for removal or demolition, as herein described. Tho applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and reg~ations, and to admit authorized inspectors on premises and in building for necessary inspectio.n~. · · · ~'~ ' ' · ...'.Z/.~..~...d~...C~...~..."..3.~,~.:~.. -- (Signature of applicant, or name, if a corporation) ................................... (Mailing address of applicant) State whether applicant is owner, llsse architect, engineer, general ~contractor, electrician, plumber or builder. N ,e owner of pren, es ... ................ ..... - (as on the tax roll or latel$A~d)j~_~B p # · . .~ . . i ~ ' ' ' If a~plic[n~ Isa c91[poratlon, sl,.natnre of d~ly author)zed officer. FEE: ~~Y: .... ."~..L(/;J.~..' ."[-t~/L~.~..~;../. ;~... ,//,/, ,/.,~-~, ~/%/..~_..~ 765-1802 '9 .AM TO 4 PM' FOR THE · / ' (Na~a~nd t-Jtle of coq}o/ate ~fficer) FOLLOWING INSPECTIONS: , 1. FOUNDATION - TWO REQUIRED ' h applicable): New,Building .......... Addition . .'. .3, ?tu.re of work (c~heck whi~c ....... Alteration ....... ~epazr .............. z~cmoval ........ . ...... Demo on . .. Other Wor~.~.~ [~'q ~ e" ...~ ' ; ~ (l)cscriptios 4. Estimated Cost ..... ~ ~ ~(to be paid on filing this application) 5. Ir dwelling, number of dwellihg units ........... Number ol dwelling units o:l each lloor.. ~ ......... ." If businc'ss ................................ 6 l~garage numberofcars : , commercial or mixed occ,lmncy specify nat,re and extent of e[ach type of use ' ~ ............. 7 D~ nCllSlon~ ol cx~stl~lg structures if Ft '' ont any: Rear ,~' Depth llcight Number of Stoiics . .Dimensions ~f shine structt, e xvith air, rations or additions: Front ....... ~ ....... ~ Rear ...... ~ ... Heigbt~ ~.'~' Ct.~ Nu -~ .'~... .... ~ ......... ,xcar . .~.~ .. .... ~acptn' ..1~ . .. 9. Size of lot: Front t~Dz ' .-. ~;~4 > .......... .'~ .......... -"'.' · ..... 7. v~ ........ ~car .. ~o.~ . 10 Date-~" · ............. : . Depth .~..M .... 12. Does proposed construction violate any zoning a~, ordin,mce or regulation:[ ... ~.0.:~; ...... J '~5 ..... 13. , Will lot be regraded ...... ~ ~ ................. Will exc~ fi I be r~mov~l;rrom~premi~es. ~e'~' Name of Archflect ......................... Address ............ :.. pho-~ 15 ' Is this -to-err- wltbtn ......... ¢. . ¥,. -~;~L~.~one~o~.~ .... ~ ..... ~ ,, . v P . y .~uu reef or a cz,az wet,anal VCYes.~q~h~ '. *If yes, Southold Town Trustees I'ermit mav be re~,;~;~ "--"K~t~Y"7 Locale clearly and di~'tinctl ~ · ' · ' ' · · ' '.~ ~ : . . . ~ ,, y I bmldtngs, whe0~e[ ex:stmg~or,pro ~oset.~ a~fl'indicate all sot-back' ',.,t~eny nnes. o~ve ~[rset~m,olock number'o[ descBption accord no to deed ,a'fi.~ ...... ~x · .;.~L. ' ' 9r or corner lot. . ~ .... ~ . : ..... t neth. 'oubrry OF... S.S ................................................ br, ing duly sworn, de m:;es and says that Im is;the applica'nt (Name of individual signing co~tract) · the ' (Contractor agent porale officer, ct( ) ..... said owner or owner~, and is duly authorized to perform or Imve pcrfomm'd the] saki work ,ami phcafion; that all statements c, gq!aincd in this application are, tz',e to thc best of is knowledge and belief; hr~d that the '.viii be performed in the manner set 'for'th in thc applicalion filed therewith. 'om to before hie this ...................... day of ....... , ............... 19 . . . ar3, Public, . ................................ County (Signature of applicant)