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Home My WebLink About22944-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. N~0 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22944 Z Permission Is hereby granted to.~/~ /"fl / ..~?...q...~. ....... ~.../.~.~ ........................ ............. ~......~.,..~~.: ................ .......... /~.~....,.~ ....... ~.~ ...................... ,o.....:.~.~.....~...~~.~~~..~..~.~~ ....... ......... ...................................................... ~..~....~-~ , .......... .../...;..~. . ........................................ County Tax Map No. 1000 Section ........ ,,~,, ..~... ..... Block ...... 19.,..~,,~..,,...,, and approved bythe pursuant to application dated ............. ..~,..~ ...... ~...~.. ...... Building Inspector, Fee $..~.~.....~ Rev, 6/30/80 FORM NO. 1 TOWr~ OE SOU'r. OLD BUILDING DEPARTMENT TOWN HALL . ~ern, it No ~.~F~ . BOARD OF tlEALTII ....... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FOltH .............. flAIL TO: Disapproved a/c ........................ i /~ ........ ': ' ' , ' ' · APVCATION FOR BUILDING'PERMIT INSTRUCTIONS a. This 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 pnblic sti'eets or areas, and giving a detailed description of layout of property muir 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, 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 or in pm't 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 Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, m~d 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, buil~q~ code, tiousing co~le, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~ ~~ . -- ' i'Sigff/~ '. '~(~,.a~pti~ont, or name, if a corporation) : (M,aj!ing ,address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plnmber or builder. ....... ................ ..................... .,~/.-- / , n,e owne, of .... .':.. ................. (as on titi~t.a~"~)ll;o~'fltesl~'~{'g&lY ": ':, '.." If applicant is a corporation, signature of duty authoriied officer. > (Na~ne and title of corporate officer) Builder's License No .......................... Plumber's License No ..... ' .................... Ele..ctlic~s ,Licens{} No ....................... t. Location of land on which proposed work will be done .................................................. llouse Number Street }Iamlet County Tax Map No. f000 Section . . . :. :~.~ .......... Block ..... ~ ....... ~... Lot ................... Filed Map No. Lot Subdivision ........ . .......................................................... (Name) , State ex/sting use and occnpancy of~)remises and intended rise and occupancy of proposed construction: a. Existingnseandocc p, y ...r}~..... ~ ................... .}:..,.{ ,:;....,...: ................ . b. Intended use and occupancy ................... ' ......... ,t~:. ,~ ........' .... '.; · .' ................... Nature of work (check winch app mable'}. New RUiMino ,.epa,r .............. ,qemoval ............. . Demol tion . Other Wor¢ '~ 3' .... 5. : ' (to be prod on filing this appl,ie~6n) ~d occupancy, .... 6. lC business, commercial or m~.xe specify nature and extent of.each type of use .... T'7':~-~ ...... 7. Dimensions of existing structures, if any: Front... ' .... lleight , .: .......... Rear .............. Depth ........ ............... Number of Stories . ........... ' ....... Dbnensions of shine structure th alterations or additions: Front ................. Rear .................. 8. l)imensions of entire uew coostmction: Frout .............. Height ... ~ .......... Nnmber of Stones Size of lot: Front .......... q ........ ~.. Rear ...................... ~pth ....... ,~ ............. 13. Will 10t be regraded ...... '~0 ' .............. Will excess fill be removed from premises: Yes No 14.Name of Owner of premises ..... ~&~..O~0~ Aa&ess ~ ~/.m.~O .... ehon~ No.~¢m ~.~ Name of Architect ............. ~ .............. ' ....Address ......... 2 · ', · Name of Contractor ~ .~.~ ........ Address ~ ~ ~' Phone No ..... ~ ....... 15. 19 this property within ~00 feet of a tidal wetland'/ '~Yes..' ...... No ..... ~.. '' ~I~ yes, Southold Town Trustees Permit may be required. PLOT DIAG ~M Locate clearly and distinctly a l,'bmld~ngs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block gumber or description accord~ to deed, and show street names and indicate whether APPROVED ,RS NOTED DATE: !, B.P.# ' FEE: ..... ItY: ~ N NOTIFY BUILD NG DEPARTME T AT 765.1802 9 AM TO 4 PM FOR THE* FOL LOWING INSPECTIONS: 1. FOUNDATION I- TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRON8 STArI'E OF NEW YORK, COUbR'y OF .............. SiS .... '~'~' '~'Q'~'.. (~)~' .'~.. · .~. .............. . ......... being doly sworn, deposes and says that he is tile applicant (Name of individual signinlg contract) ' above named. Ile is tile ............. (C ) "' · ~ ontractor, agent, cor'porate officer, etc. of said owner or owners, and is duly iauthor zed to perform or have performed the saki work and to make and file this application; that all statements coutait~ed in this application are true to the best of Iris knowledge and belief; and that the work will be performed in the manner ~et fort in the application filed therewith. Sworo to before me this i ........ Notary Pnblic ..... ~ ~L,.~~ County /~1 ' ' (~. '.~..'~¢L~ [ NAftary Pub!lc, State of Now York' . .... ~//-..-~.. ;~..'7'."v... ~-/No. ~,952246, Suffolk Count~ .// // ...................... TermExpiresJul~e, 12,19_212 . // ' (Signature of applicant)