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Home My WebLink About22937-zFOBM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N9 22937 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Seoflon ~/ Block ....... ~ .............. LotN~ ~ ~ pu,,uon.o app,co,lo, ua,ed ................ ~~...~ ~ 9....~ ond app,oved bv~e BU}I(~ Inspect?~ ~.~.~,. Rev, 6/30/80 SEN? BY:P ~ & L 5160550607;# 2/ 2 '! TOWN OF SOUTHOLD BUILDING DEPARTMENT B~)ARD OF HEALTH F. TS OF PLANS ] ] .... ]'' J/~URVEY ................ : ~CII£CK ................. /SEPTIC FORM . .. ~ ..... .... ~ ~ ~ TOWN HALL SOUTHOLD, N.Y, 11971 /') J TEL.: 765-1802 hO,: ,: FY, ~1__ ,~._f~,, Exa~ md .~.fc.- 19/~./ ' .,, ,--, ~ ~ .............. ...... · ../ · MAIL TO: · .................... ..... ........ . , Dsa~ roved' Mc ..f/.. / ' "~ - "-' ' ~ ' ..... " .... - .................. ..... ilh / · A~,PL~ ' F U LDINGPERMIT " ' [/L/ ' Date ................... 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 "sets of plans, accurate plot plan to scale. Fee according to schedule· b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eets or areas, and gi~ing a detailed description of layout of property muir be drawn on the diagram which is part of this appli- c. _The work covered by tiffs applica,t, ion may not be commenced before issuance of Building Permit. · d. Upo~ aPpro',;a(gf this applicati$~' the Building Inspector will i~sued a Building Permit to the applicant Such permit shall be kept b,h the pr~e, mise,s ava,iJoable f6,.,t,.inspection throughout the work. e. ,, No building shall b.% oc,qupied 6r i~sed in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been grapted I?y t, he Bui.lding Ihspector. APPLICATIO~ IS }JI~REBY'.,MADE to the Building Department for the issuance of a Buildin Permit ursuant to the Bmldlpg Zoge-Ordln~n~.of the i~9,wn of Southold Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, ~)r ihd ~bn~t'/tic{ish'~i'"6ulidlngs additions or alterations, or for removal or demolition, as herein described The applicant,agrees ,to co/nl~l~)"~ifh all'applicable laws, ordinances, building code, housing code, and regu!ations, and to admit authorized inspeet(~s on premises ~nd in building for necessaryj~/l~ections. ,,----) ~ . ~'* ' ' ' (.Signature of applicgpt, or name, if a corporation) · /O 7to /I/'o~ 77/ A/.g, ~ t t,/~- ' ".':'?: ' ,: ': t: .,,: !'~ .-., .r (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of pre~nises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer.' (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. : House Nmuber Street Hamlet County Tax Map No. 1000 Section .: .' ........... Subdivision ........ . ................... ......... '. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /b/O ('/~-'". ' b. intended nsc and occupancy ~.~. [,~ ~-Jb/'~" ( kwh ppli ) ' Additi Alt atl ' · 3. Nature of work chec ich a cable: New Building ......... on .......... er on .... ; ..... Repair .......~j ..... Removal ........... Demolition ..... Other Work .~.~.n,"6~-'. °° '" (De iptin) scr O 4. Estimated Cost ,~ 5. If dwelling, number of dwelliug nnits ..... ./ (to be paid on filing this application) · If garage, number of cars .... .O. ......... Number of dwelling unit! on each floor ................ 6. If business, commercial or mixed occupancy specify natnre and extent of each 7 Dimensions of existing structhres if any: FrOnt Rear ' ' .............. ' ..... type of use Iteight Number of Stmies ............................. Depth ............... Dimensions of shine structure w' ' · . Depth ' ~th alteratm is or add,hens. Front ................. Rear .................. Height , Number of Stories ' ' · Dimensions of entire new construction: Front Rear lIeight Number of Stories .............. : ............... Depth ............... 9. Size oflot: Front .. O~..o~ ..... . Rear ~..o.."... ; . i... e th .o~.~.o..r 0. Date of urchase ............... D p i ..... ........................... .. Name of Fenner Owner .~?/~..7~. ~.~ .... I. Zone or use ...... 2 Does proposed construction violate zoning law ord~nm{ce or regulat on: ' d~stnct ~n which premlses are situated ..................................................... · any ]. Will 10t be regraded ....... : .................... Will excess fill be removed:from premises: Yes No . Name of Owner of premises ........... , ........ Address .......... i Phone No .......... ' Nmne of Architect Address ............................................. Phone No ................. Nmne of Contractor ....... ' ............... Address ................... Phone No ............ ' .... 5. I.s t:M.$ propert:y within 300 feet of a tidal wetland? *Yes ......... No ......... ·If yes, Scut:hold Town Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indiCate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show Street names and indicate Whether iterior or corner lot. ~IOU~E! NOUDflUJ. SNO0 UO MOa ~lltl6NOdSgU £ON '$aCiOO A~IgN9 ~ NOIJ.DflU.LSNOD 9.L¥.Lg 'A'N iIH.L 40 ~.LN3fl:akllI1o:IU gHJ. .I~IPl 'I'IVH~ NOI.LDflU.I.~NOD 'O'D UO't ~,l.~dlNOD ~-~lllfil NOI.LDilU.LSNO3 ' qYNtd "P NOLLY'IIISNI '$ ~)NIglNnld ~' DNII~r~I.4 ' H~'tOU '~ ~IaUDNOD (IgUflOd UO:I QaUIflO3U 0~1. ' NOItYQNflO~ :$NOLLDadSNI DNI~AOTM aH.L U~ t, OJ. lilly 6 ~081.'g9/- 'ATE OF NEW YOMRI,~,., ' )UNTY OF .... ,~. ,z~{~ ~%. ..... S.S (Name of indlvidual signing contract) ~[['~ ~ (ContraCtor: agent, ~orpo~ate officer, etc.):: ,~:.'~ ~ ~G~ ~ ~,1 ~ ~//~, said owner or owners, ~d is duly authorized to perform or lmve perfommd the smdWork and to m~e a~d ~le~his ~lication; that all statements contained ~ this'application are ~rue to. Ihe best of his k~owledge and belief' and tha~ rk will' be perfo~ed in the ~er set forth in the application filed th~,ewith. ' ' ' om to before hie this /~ ~o. 45t~08~. ~o1~ ~ou[~, . ', ' (Signature of applicant) . Term E~ire~ ~ay 31, 19~ ·