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Home My WebLink About22496-zFORM NO.3 TOWN OF $OUTFIOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_o 22496 Z Permlssionlsherebygranted to: '- .~ , /1 /~ ........ to ....~,~.~......~...~.,~~....~:, ' .................. ~ ~."~"~? ~-~ ............... .~..~..~.~. ....... :..~.~.~.../.....~..~.~.......~........~z~.,./,-_~ ....... z .......... .. ~ ~,~.... :~,~..~.. ~~..'/...,~.~. ~...~ ......................................................... ............................................ ~.¢.~ ......... ,~.;..~ ........................................... ~0o0 seo,,on...~..'~.......~ B,oc~.....~. ............. LotNo...~.'..~ .... Counf,/Tax Map No. dated '/~/~;~ ~/ .,/. ~'~' ,19 ~ ..~.., and approved bythe pursuant to application ................................. : .................................... Building Inspector. Rev. 6/30/80 Bulldln~ ............... ' TOWN OF SOUTHOLD gUILDING DEPARTMENT · ~,l~q\! I 5 1994 TOWN HALL ..... ,i SOUTHOLD, N.Y. 11971 BLDG. DEP't', TEL.: 765-1802 "' ~ICATION FOR gUILDINGPERMIT B~ARD OF HEALTH ......... 3 SETS OF PLANS ...... SURVEY .................. CIIECK ................... SEPTIC PORM ............. CALL ~ .... MAlL TO: , INSTRUCTIONS ., a. This application must be completely filled in by typewriter or in ink azfd submitted to the Building Inspector, with 3 ~ets 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 giving a detailed descriptioi~ of layout of property must be drawn on the diagram which is part of this appli- cation· c. ' The work covered by tkis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wlil i~sued 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 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, 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 neCess~ .~.~.' --' ' (Signaiure of applicant,/~n~e, if ~ corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. ·...~/t,,,Z.,a ~ ................. ,...' .......... ~, ...................... , ...................... '. .... N~me of.owner of premises... ~ .~.Z'///. ~.K~../~L./~ff(.a~s ~n~a.x. ;o'li ;; i~t;;t' c~;;d')'''} ..................... · : "(Nam~d tit~'~r'a'te' ~}~;;r')' ....... Builder's License No .......................... Plumber's License No ............... . .......... Electrician's License No ................ . ....... Other Trade's License No ...................... 1. Locationo'flandon;hichproposedworkwillbedone.....~/.'~/.Ol~--~./Z~.... ~-..~~/7.~..~. County Ta× 1000 Section.: 5'--C. .......... Block Subdivislon..: ..... ., ' Filed Map No ............... Lot ...... : ........ (Name) , : Stat~ existing use and occupancy ~mTs and intended use and occy/ancy of proposed constructioni a. Existing use and occupancy.../. [.~...~ .,:~. ...... ~..r<'.4°.~' .c'~-.. ........................... b. Intended use and occupancy ..................... ' ......................... '.- ..................... k ( ' ppli ) ilding 2 Additi ' · 3. Nature of wor check which a cable: New Bu ~ ,,!,, . ......... · · ....... Alterations....;.. i. Repair .............. Removal .............. Demolition ..... '. ~'~ ..... Other Work. · ~ %.~'-1~)i .... ' ' (D ipti ) i ' escr on 4. Estimated Cost ................... Fee (tO be paid on filing this application) 5 If dwelling number of dwelling units ' Number of dwelhngiun~ts on each floor · If garage ' ' ............... · ....... ......... · , number of cars ............................................. . .... 6 If business commercial or roi.xed occupancy specify nature and extent of 7' Dimension's of existing structures if any ' . .eacll type of use ..................... · ' Front .. . R~* Depth Height Number of Stories ' Dimensions of shme structure with alterations or additions: Front Depth ' Height ........ .......... Rear .................. .......................................... . · · Number of Stories ' ' 8 Dimensions of entire construction: Front ' · new ' Rear I ...................... Height Number of Stories ................ ' ....i .......... Depth ............... Size of lot: Front ; Rear ' ........ i ' ............. : Depth Date of Purchase .................. ........................ Zone or use ................... ' ....... . . Name of Former Owne~ . district in which premises are situated .... Does proposed construction violate any zoning law .................................................... ordinance or regulation: Will 10t be regraded ................................ ....... : .................... Will excess fill be rem6ved from premises: Yes No Name of Owner of premises Address ............................. ·. · ~ ...... Phone No. ........... ;... Nam~ of Architbct ......... . .... aaa .... . ...... I; .... Phone No ............ : .... 15.' 0 aa 'a' a ? 's.'.'..' . .'.' No ......... · If yes,'Southold Town Trustees Permit may be required.I .. PLOT DIAGRAM Locate clearly and distinctly all buildings, Wheth&r existing or proposed, andi indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 10. 11. .12. 13. .14. 2, ~OiJGH . FRA~ING & PLUMBING, 4 [f~Nak CONSTt:~UCT~ON MUSt 8E COMPLETE FOR C,O. ALI2 CONSTRucTION SHAEL TFIE[ REQUIREMENTS OF THE ST/~ CONSTRUCTION & ENERGY COU~. NOT RESPONSIBLE FO~ DES}GN OR CONSTRUCTION ERROR~ STATE OFNEW YORK,,. , S S cou , r · ...... ..... . .... (Name of individual signin~¢tract) above named· ..... being duly sworn, de2oses and says that he is the applicant (Contractor, agent, cor'porate officer, etc. of said owner or owners, and is duly authorized to perform or have performed the ;aid work and to make and file this application; that all statements contained in thisapplication are irue to the best of his knowledge and belief; and that the work will' be performed in the manner set forth in the application filed therewith. Sworn to before me this .... I . . ' ,o ' Notary Public, .... .r~./~~ County ' ' , / ' . /I .-. ____'-, 2/ _~ ~..-.~ .., ..-? ...-~ . // ' ...... "' of N,~, ,v ' ' ' ,A's,~nature of applicant) . NOTARY PUnt C, Stat~ // ' ' , ' ' , No. 4725089, Suffo k Coul~lt,,// ~ ' Term Expires May ~1, lg.,T..~,