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Home My WebLink About22497-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .......... ~./.. ............................. 22497 Z , ...../.~~ ........... ~:.~, ...... .//...¢...,¢,¢' CountyTax Map No. 1000 Section ....... ..~....~....~... ..... Block ......... ~ ..........LotNo. ,...~.. ...................... pursuant to appllcotion dated ................ ..~.~..../....~.. .............. 19...~....~......, and approved bythe Building Inspector. Fee~..'?.~ ..... Rev, 6/30/80 " LATIO:I PER '~. STATE E}:ERGy CODE ADDITIOU~'L COMi-IEIlT$: Examined . . ~/ ..... , 9?¢ .... Disapproved a/c ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 /ICATION FOR BUILDINGPERMIT INSTRUCTIONS BbARD OF HEALTH 3 sETs OF PLANs SURVEY CHECK hOr,py, CALL ................ HA'IL TO: Date // ~ 9~.'-/ a. Tiffs application must be completely filled in by typewriter orin 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 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 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 Southbld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fo~ removal or demolition a'· ' T.he ,app,li. cant a~rees to comply with all applicable laws ordinances building/code h,~,~i ...... ,~ s lie,re..m descnb, ed. aamir autnorizecl inspectors on premises and ill bui~lding for necessary inspT~~..-o~~u regulations, and to ( ig, rf~ture of at;plicant, or name, if a corporation) ~ (Mailing address of applicant) /L/. State whether applicant is owner, lessee, 'age't, architect, engineer, generai contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature 6~f duly authorized officer.' : (Name and title of corporat~ officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ..... . ....... : .......... Other Trade's License No ~ I. Location of la'nd on which proposed work will be done ................................. ~ ................ House Number Street Hamlet ......... Couhty Tax Map No. 1000 Section ............. Block ........... Lot ................. Subdivision ........ . ......... ' ................... '. Filed Map No. (Name) .............. Lot ............... 2; State existing use and occupancy of premises ~..:: .ge'J :: ' occupancy of proposed construction: a. Existing use and occupancy .. ~ ... ~' ~ '.~' -. ....... . .... .............. .3. Nature of work (check which!applicable, ...... . . ' . Re-air .... ,, , . ~: ~ew ~uuamg ......... ; Addition .......... Alteration v .......... v~elmovm .............. . Demolition .. . . ..... :Ot~r Wgtr~,i .............. 4 Estimated Cost ~ .O. -- ~:.~.. ~ ' ~ .-~.~. (Description) i (to be paid on filing this application) 5. If dwelling, number of dwelliog units ............... Number of dwelling units on each floor · If garage, number of cars ...i .......... ' ................ I.f.b 'ne ,m · i.8 ~ .... ~"; ';'an .......... 6. us~ ss, co merclal or m ed occupant , spec na u d',~t,.,* ,,'r'JJJ~',~. J .................... ~ .... 7. Dimensions of existing structt~res if any. Front /9~. -"%7, ...... ,,a~t t_,ype o~ use ........ ~ ...... , .... Hei"ht ~ ,., ~' .... ~ ........ ~ear ...g-.~. ..... De,,th e . · ~ ........... r~Umber of Stories .. ! ........ Dimensions of shine structure with alterations or additions: Front .... ~...'-4-. ......... Rear .... 7_~, ..... 1, .... Depth .... 2-.a) ........ i ....Height ... '. J. (,a., .. ........ ;., Number of Stories..,,9~ ...... '.; ........... 8. Dimensions of entire new conatruction: Front ... 2.~ ...... : Rear .... .'~..~. ...... Depth ...7~.~ .... ~ .... Hight /.~ Nhmb fSt 91 ' e ............ er o ones · Si fl F O~t~ -~f q~-~ [ R ..................... %' zee o[1 rent .. .w~ . . .. ear . ' -- ' ...................... I0. fp te~$:? · ~ .......... ; ......... ~eptn ................ /' 7'~t ":~. N fF Ow ? ..... 11 ~ate o urchase ..... . ....... . ......... amc o ormer net ............... di hi h p d O. AJ. 7t?..tx~ · · one or use strict in w c remises are situate ... .... · ........... 12. D · ' . '13. oes proposed construction violate any zoning law, ordinance or regulation: Will ld t be re,faded . . A/r-> .' ' , .... · ........................... x,~ ~,-,-, ~ ~ ' .' '~LM,',3 ",'; ...... +, .....wm excess fill be removed from "remises' '-'- -, · , ........... -:~-... ^uuress . .,~ .~..ad.~.o..~T'' ......Phone No Name of Contractor ..... ' . ....off. p.a.. ' · ~ ................ Address ...; ........ ; ...... Phone No ............ '. 15.' I.s this property within[ 300 feet of a tidal wetland? *Yes ........ No.~ .... ''' · If yes, SoutholdjTown Trustees Permit may be required. '' · . i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc interior or corner lot. number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTy .e:q .... . (Name of individual signiOg contract) ..... being duly sworn, deposes and says that he is the applicant above named· . . ~ t ' Heis the 3 ' i (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this tpplication; that all statements contained in this'application are t'rue to the best of his knowledge and belief; and t mt the ,york will be performed in the mannerjset forth in the application filed therewith. ' ;worn to before me this 4otary Public, .... ~o. 49_52246. Suffolk Coun/3f ~ ' ...... ~/ ....... : ........... ' Term Explre~June 12, 19~% .. . . ', t.~ (Signature of applicant) .