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Home My WebLink About22581-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] N~ 22581 Z Permission Is hereby granted to: z~) .......... ../.G~..~~ ................ ............ ~..~~.~.....~...,...i ........... to .~.~...~...~... ~.~...~~,...~/~.~.. ~ .................. .... ~ ........ ~?~...~.~~.......-.. .......................................................................... CountyTaxMapNo. ,000 Section ...... .~...,~... ...... Block ........ pursuant to application dated ....................... ~.,~..._.....-~....~..., 1 g...~.~ and approved bythe Building Inspector. Fee $. -.~:~..,,,. .............. Rev. 6/30/80 i / BOARD OF HEALTH ......... 3 SETS OF ?LANS ......... SURVEY .................. CIlECK CALL ~. HAIL TO: Disapproved a/c ............................. : ..... . t · ' A~/142ATION FOR BUILDINGPERIVtlT Date ....... : ........... 19 ... 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. r b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti-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 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 part for any purpose whatever until a Certificate of Occupancy shall have bee, n 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, 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ (Signature of applicant, or name,L ofpora io,' (Mailing address of applicant) //~ ~] State wl~ether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. ............ ·, Name of owner of premises . ~ kO .~'"'~ ~ ' n ( 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 Lmense No ......................... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Nmnber Street Hamlet County Tax Map No. 100OSection .. , :, .7. .~. ....... Block ..... .~. ..... ' .. Lot .... z~.Z ............ Subdivision .... p N ....... , .......................... Filed Ma o. (Name) .............. Lot ............... State existing use and occupancy of prmmses and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ . .~..O...r20..4~ ................................................... b Intended Use and occupancy . Locate clearly and distinctly all property lines. Give street and block interior or corner lot. I '3. ature of work (check which iapplicable): New Building ......... Addition .......... · · Alteration .... t~'~'' '. Repmr .............. Removal .............. Demolition .... : .... Other Work ~ ¢. .... (Description) 4. Estimated Cost .. oO, .--7..i. -- ! (to be pair[ on filing this application) 5. If dwelling, number of dwelling units ' · If garage, num her of cars I ............... Number e£ dwelling Units on eacl~ floor ............... 6 I.f. bu '.e 'I '' ' ......................... OCCU~ ..... .~ . , ................ . . · sin ss, co.mmercia or mix,ed v,~-uy, s ecny nature aha extent of.car l 7 D ' t type ofusep .................. · ~mensmns ot ex~sting structures, if any. Front . -. .............. ? .... H 'ght N i fsi .... i ......... l/ear ....... pth De .. e~ ............... u nber o ories ......... ' .... · ......... Dimensions ofshme structure ivith alterations or additions: Front ~ ' D pth · e Hight ................. R · · · ear...... 8 Di i f t .............. ;.. Number of Stories ........... ~ ....... · H mens OhS o entire new cons ruction: Front .............. ; Rear ............. De .. eight .............. . Number of Stories ......... .. pth ............. 9 Si fl 10' Dze° ot: Front .......... , ............ Rear ..... De ............ fP . pth · ate o urehase ...... ~.. . .............. I1 Z ................ N ........ ; . · .... amc of Former Owner ....... · one or use district in which premises are situated ............ ' ............. : ....... 12 D.o. idl ........................... · es proposed construction v ate an,, z,-~:-h , ............ 13 Will 1 d d , J ,~--,u ~aw, oratnance or regulation: .......... ' ' ' · "! Will b . ot be terra e ....... . .................... excess e remov 14. Name of Owner of premises .. ~. . -~, d from premises: Ye o Name of Architect ....... [ ..... · ~maress ................... Phone No ............... · ' ' '" · ........ Address ................... Phone No ............ :...: Name of Contractor ........ i ....... ........... Address .... . .... v ........ ~. No ............... 15.' Is this property within ~00 feet of a tidal wetland· *Yes ........ No · *If yes,~Southold ~own Trustees Permit may be required.· ...... PLOT DIAGRAM ·. buildings, whether existing or proposed, and, indicate all set-back d~nensions from mmber or description according to deed, and show street names and indicate whether APP. ROVED AS NOTED '/' FEE: _.~~ BY' NOT~Fy 'Rt.IILDING Oi~'P~ 7~5-1802 9 AM TO 4- PM FOR THE FOr.bOWING ~NSPECT~ONS; FOR POtJ~'D CO~CHETE 2. ~O[JGH . F~AM~G & PLU~BtNG 4..FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. '. ALL CONSTRUCTION SHALL ;" i THE REQUIREMENTS OF THE i STATE CONSTRUCTION & ENERGY i CODEs. NOT RESPONSIBLE FOR TATE OF NEW YORK~ z, DESIG. N OR CONSTRUCTION ERRORS ' oum'¥ OF.. ............ O.. g .......... I ........ · ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) )ove named· i ........................ ~' is the " · (Contractor ............. ' .............. agent corporate officer otc ) ' ~.ajd..owne.r or owners, and l's duly a~thorized to perform or have performed the said work and to make and file this p icanon; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk v,;ill be performed in the manner se!t forth in the application filed therewith. ,om to before me this ?o'W,c .. , ' . ,- .......... ? ...... ..... / .......... Y/ .... I'l''","l .... ~-ounty /'"'b :,,---.. ' - · ('/ .. SUSAN J. TOPPING , I . . ' N,o,t_a~..P_u_bllc, State of New ...... ~ .... : ; · C~_.?,:~?OlSO. Suffolk Counht,m,~_ . -- · .... / .' - ~,~,..-f__.~ · .~ · · ·;' · ~r,,rnlsSlOn Expires July 20 l~_~r.~ ' ' · , ' / ~,:>~gnature Ol apphcant) ·