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Home My WebLink About22530-zFORM NO.,3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) "2- Date ,.../....~ ............................................... 19..~, ,,~,,.. 22530 Z Permission is hereby granted to:., 7~...,.~.~..~ ........ :~~..~ ~....~./..........~.~o ....... Coun~yTax Map No. 1000 Section .......... ~ ........... Block .............. ~.... Lot No ....... ~ ............... pursuant to application dated .......... .~,~'~-... ............................ Building Inspector. 1 9...,~...~......,, and approved bythe Rev. 6/30/80 Disapproved a/c ' ' ~m~mg~pector~ APPLICATION FOB BUILDING PERMIT TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN tlALL SOUTIIOLD, N.Y. 11971 TEL: 765-1802 INsTRucTIONS BOARD Or IIKALTII ......... 3 gETS OF' ?L.l, ilS .......... SURVEY ................... CIICCK ......... · .......... $ EI'T'[ C ,F'O RH .............. I;OT! P'! J CALL ................... {-IA I L TO: ~. a., T. his appli.cation must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .ets om plans+ accurate plot' plan to scale. Fee according to schedule. b. I lot gl~n. sllow[tlg location of lot and of buddmgs on premises, relatmnshtp to adjotmng premises or pobhc streets )r areas, and gtvmg a detailed description of layont of property must be drawn on the diagram which is part of this appH- :alien. c. The work Covered by tiffs application may not be c~mmenced befor~ issuance of BuihlJng Permit. d. Upon approval of tb's apphcation, the Bnildlng Inspector will issned a Building Pe~it to the applicant. Such pe~it · hall be kept on the premises available for inspection thronghont the work. .e. No bniJding shall be occnpied or nsed in whole or in part for auy pnrpose whatever until a Certificate of Occup~cy hall have been granted by the Building Inspector. A~PLICATION IS IIEREBY MADE to the Btnldnlg Department for the lssuauce of a Buddmg Pe~R pursuant to tho Juildmg Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable ~ws, Ord~ces or ~egulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Hie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Jdmit authorized inspectors ou premises and in building for neccssa~ inspections.~__ __ __- ' . _ ., ....... ' ' (Signature of applicant, or ~me. if a corporation) . ' (Mailing address of applicant) Ii State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pre{roses .' (as on the t:~ roll or latest deed) If applicant is a corporal{on, signatnre of duly authorized officer. ...... (Nn~ and t,tle of corporate officer) L:lcctr C a } S License No ............. ..... Location Of land oil which proposed work will be done..' ...................................... I Iotl~C Nnmber Street Ilanllet Conll ax np ectJon .............. . oc ................ . Lo{ .............. ..... . Snbdi~ision ' Filed Map Ne - · : .............. Lot ............... i'Manle / . ~. Slate existing t!se. and occnpancy of premises and intended use and o6cnpancy of'6roposed construction: Existing use and o~cupancy 3. Nature o£wo~k (check which aplflic:,hle): New Building .......... AddiHon .......... Alteration .......... Repair ........... ~ · · Removal ............. Demolition .............. et let Work ·"':~'/~'~/'/;c., . . .'~'-~ . ~{'DescHpt on) $ Estirlated C t ~. 1 os ................ I ...................... . on fihd~ tins apphcatlon) ' IfdweIlin§,humberofdwellilmunit ~'. s Number of dwelling units oi~ tach floor If garage number of cars ............... · ............... i If business 'omnmrcial or mixed occupancy specify nature and extent of each type of use ~. DinlenSlolls of ex'$tjn~ ~fnlt. h r,,~ lc L .~ . t, · . . ' , , o ........... , .. Lilly: Pro It ......... (ear Do.th tlellgut ...... ..... ' ................................... lslon$ o1' sanle struttnre with a ................... terations or additions: Fro it' . '. ............... Rear ' I. D ...... : ..... ,-_ .. ~ght .................... Nt illber si Storms ..................... .,,m,~m,~ m enure new constmcti? ~: Fro. at ............... Rear .............. Depth ... [?ight .... ............ Number of Stories ................. ' ......... ). Size of lot Front .. ' .............................. ). Date ofi~urchase ............ * ....... ~qear ...................... Depth .......... :: ........ : ·. ' { ..... ' ......... Name of Former Owner ' ~u.u ur use Olscrlct Ill WlllC]l prenllse:s are strut ted ..~ Does proposed construction violate a]ny zoning 10w ......................................... , ordinance or regtllat{on: ..... ~ ............ ~ .............. I. Will lot bi regraded ............ ~ ............... Will excess fill be removed fronl Yes No I, Name of Owner of premises i premises .................... Address ................... Phone No ................ Name of Architect ' I ........................... Address ................... Phono No ................ Hame of Contractor ·" ........................ Address ................... Phone No ......... . ....... Is thl:iOfrop~rc¥ within ]00 f~: of a eid.l w~tl. and? *Yes... No...ff.. yes, Sour:hold T ' ........ own]lru~tees Permit may be requirod. -' ." .., ' PLOT DIAGRAM Lo':ate clearly anti distlnctly'all · · bt drags, whether existing or proposed, and, indicate all sot-back dimensions from operty 4ines. Give street and block number or descriptloll according to deed, and show street atones and indicate whether tefior or corner lot. ATE OF NEW YORK, ~UNTY OF ........ .... ... .. S.S (N,uue of tudlv dt al signing CC we named,' F~)LL()Wti~zG ~NSPECDONS: FOe POURED CONCRETe 2, ROHGH * F~AM]NG & PLUMgiNG 3, INSULATION 4, FINAl. - CONSIRqCTION M[JS BE COMPLETE FOR C20. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STAT~ CONSTRU~ION · ENERGY COD~$. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ntract) being duly sworn, deposes aud says that lie is tho applicant ,i (Co itractor, agent, corporate officer, etc.) said owner or o~.vners, anti is duly aut Iorized to perform or have perforated the saki work and to make and file this Ilcation. that all statements contained ,ill Ih s a* ~ cahon are tree to Rte best of his knowledge and belief; and that the rk will be performed in tile m~ner set ~orth In lite application filed therewith, om to before mat's ~ , ?HOMia F. ~NER~ J~./, ........ ~ ;%';. · .~'. ~.] ;'..~ ............. ~ .... Nota~ Publi. State of New'Y~rk // (Signature of apphcant) · No, 4806ss~ ~, ~ Quailflea in Suffolk Count~ ',