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Home My WebLink About22932-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22~32 Z Building Inspector. Fee 8....,-~.. .................. '. J/ ' Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined .., 19 Approved ., l f. Permit No...'4. Disapproved a/c ..................................... .'. APPLICATION ~R BUILDING' PERMIT INSTRUCTIONS BOARD OF tlEALTII .... ...... 3 SE~S OF PLANS .......... SURVEY ................... CHECK ......... ~ .......... SEPTIC FOlt[I .............. CALL ...... HAIL TO: Date .... 19. a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sats of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public st?eets qr 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 this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tile Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on tile 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS ttEP, EBY MADE to the Building Department for the issuance of a Building Permit pursnant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or P, egu at OhS, for tile construction of buildings, additions or ~lterat;[onsl,or for removal or demolition, as herein described. The applicant agrees to comply with all applicable l~3s; 0r~li~fland~s, t{~J~{lding code, housing code, and regulations, and to admit authorized inspectors on premises and h~building for?ri~'essary inspectio¥i~'J / . ~ -- ,., ~' .. · , ,'(S.i~na(ur9 o~appli nt, or , ' ' p ' ~i! .... .... . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder. (as on the tax roll or latest deed If applicant is a corporation, signature of duly authoriied officer. (Name and title of corporate officer) Builde,"s License No .......................... Plumber's License No ..... ' .................... Elect clan s L cense No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................. ~ ................ ............... llouse Number St f,~et Hamlet / ConntyTaxMapNo. 1000Section ...:...~ .... '. Block ........ /. .... :... Lot...~ ............ Subdivision ......... ............................ Filed Map No ............... Lot ...... : ........ (Name) 2. Slate exisling use and occnpancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ ~V~; ~ ?? :~-' '~6.' ~ ~ .................. b. Intended use and occupancy . '3. Nature of work (check which ~pplicable): New Buildi (g . ~. ,. Addition .......... Alteratio. tL~.../....~.. Repair . ' ..... · ............. Removal .............. Demolition . .. Other Work. '~/~.~/.'~..A:... '. ,(~.Za9 ~a9I ..... ' (D ipti ) ? , 4. Estimated Cost .......... ]'; .................... Fee ...................................... , (to be paid on filing this application ! · . ~ . ) 5. f dwelhng, number of dwellm~ units ............. . Number 6f dwelling units n each floor ................ · If garage, number of cars .... i ..... o~ 6. If business, cmnmercial or mixOd occupancy, specify ............................ 7. ' ' . . ( nature and extent of.each type of use ............... , ..... Dunenslons of exmtlng structu es, if any: Front ............... Rear .............. Depth ............... ]d~ight ............... Ntnhber of Stories .. ' .... witt ............................................... mensinns of shine structure ~ alterations or add tion~ Front Danth ' | ,,. . ............. Rear ............... , g ................. ~.. Number of Stones ...................... 8. Dimensions of entire new cons(ruction: Front .............. : Rear ............... Depth .... Height ............... Number of Stories ................ ' .......... 9. Size of lot: Front : ' ' ......... , .. ........... Rear ...................... Depth .................... 10. Date of Purchase ......... , ........... Name of Former Owner 11. Zone or use district in which pr~mises are situated ............... ' ' ' ': ....... 12. Does proposed construction violate any zoni ~g law, ordinm ce or re ulati · 13. Wi I lot be regraded . ,., ~ · ............ ...... ~ ................... wm excess till be removed from premises: Yes No 14. Nmne of Owner of premises .......... , · · ·, .... Address ................... Phone No ................ Name of Architect ..................... Address ....... Phone No ................ Name of Contractor ......................... Address ................... Phone No ............... 15.' Ip this property within 300 feet of a tidal 'wetland? *Yes ........ No .......... · If yes, Southold ~own Trustees Permit may ~e required. PLOT DIAGRAM Locate clearly and distinct y alii.buildings whether existing or proposed, an&indicate all set-back dimensions from property hnes. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS ffOTED NOTIFY BUILDING DEPARTI~ENT .~T 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPE~ONS: 1. FOUNDATION . ~0 REQUIRED FOR POURED CONCR~E 2~ ROUGH - FRAM;NG & PLUMB{NG 3.. INSU~TION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION 'ERRORS STATE OF NEW YO)..RICc~ .:,, ' S S .... /J0~' '~' ........... ' .... being duly sworn, deposes and says that he is the applicant (Name of individual signi]Ig con tract) ' above named. (Contractor agent cori~orate officer otc ) ......................... of said owner or owners, and is dt ly'anthorlzed to perform or have performed the said work and to make and file this application; that all statmnents contaifled gl this application are irue to tile best of his knowledge and belief; and that the york will be performed ill the~m.aoner ~et forth in the application filed therewith. ' worn to beforeme this / / i' ' ........... ~.dr...~"~.~day ~,. 4'.'"' .L,.L.',( ......... 19 .q.~. . ............- .......... . ... No. 4725089, Suffqlk COu~V~ (Signature of applicant) Term Expires May 31, 19..~, '