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Home My WebLink About22369-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) N-~ 22369 Z Permission Is hereby granted to: ~ ,~ ~ ~, ~ ~. ~ ~ ............ ~:..~...._r-..~..'. ............................ _- .~. ........... ~.¢...c~...~.~. ...... ~:.~..,. .................. ,o ...... ../.....¢.. ........ ./..~:~:.~z ........ ~ ...... ~.~.~.~ ....... >~....,...p../~~... .......... ,,~.....o~......:¢.~..~..~.......c,.~...~ ........ A~..... ~..'...~../,~.. County Tax Map No. 1000 Sectlon.,.,,..,,,,,,......~4¢~" ...... Block .......... .~. .......... Lot No. .,Z..,O., ................ pursuant to application dated ............. ~,-~.~....~.,.: 1 g...~..y.., and approved bythe Building Inspeo~ Fee $.~.,:,,.~,.,, '"' .................. ............ . ......... Building inspector~...~..' Rev. 6/30/80 ~ ~ t~,,~l~a~u ~.oil~Ll ucLion VlOla[e any zoning law, ordinance or regulation: ................................ p. 1 lot be regraded ............................ Will excess fill be removed from premises: Yes No ,.une of Owner of premises ..................... Address ................... Phone No .......... ... i... ~ i ~-ne of Architect ........................... Address ................... Phone No ......... ' ::une of Contractor .......................... Address ................... Phone No ................ 'Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... ' *If yes, Southold Town Trustees Permit may be required. ... PLOT DIAGRAM ,-ate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ;7 lines. Give street and block number or descr/ptioh accordin~ to deed ~-a o .-, ,,u ~,,~,~ ~u~[ names ana lnalcate whether N~ORJ~:). //.~$ $ .... .< ............. (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant ,~'~e,r o.r ~w~,e~r~, an,d is d.u)y au?or~ ,p. erf?rm or have performed, the said work and to make thi II ~! ~"-'-~Jll i TOWN OF SOUTHOLD ~l!ll/S'"' o n ,^~, JIJIJ BUILDING DEPARTMENT Disapproved a/c ..................................... .............. ::: ....... APP~ION FOR BUILDING PERMIT iNSTRUCTIONS ~ a. T~s a~plicatio~ must be completely filled in by typewriter o~ in ink and submitted to the Bulldog Inspector, wit~ 3 ets of ~]ans, accurate plot ~lan to scale. Fee according to schedule. ; b. Plot p]~ show~g location of lot and of build~gs on ~emises, relationship to adjoining premises ut pub~c streets ~r areas, and giv~g a det~Ied description of layout of p~operty must be drawn on the diagram which is pa~ of this :ation. c. The work covered by t~s application may not be c~mmenced before issu~ce of Building Pe~it. d. U~on approval of t~is application, the Building lnspecto~ will issued a BuJld~ ~e~Jt to the app~cant. Such pe~it h~l be kept on the premises avaQable for inspection t~roughout the work. e. No building shall be occupied or used in whole or in p~t ~o~ any purpose whatever until a Certificate of Occup~cy hall hav~ been granted by the Building inspector. ~LICATION IS ~ER~BY MAD~ to the Bulldog Dep~ment for the issuance of a B~]ding ~e~it pursuit to t~e ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New Yo~k, ~d othe~ app~cable ~Ws, Or~ces (egulations, for the construction o~ bu~d~gs, ~dditions or alterations, or for re'oval or d'em'o'li~bn, as he~e~ described. ~he app~cant agrees to comply wit~ a~ applicable laws, ordinances, b~inB~de, hoBsJng code, and ~eguhtJons, a~d to · .. ................ -- t 'g ' pp ' , me, if a corporation) ... .ex. ~ (Mailin~ addres~f applicant) hate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... .............. .-. ....................... qame of owner of premises .~.. ~~. ..... (as on the t~' roll or latest deed) f applicant is a corporation, signature of duly authorized officer. BOARD OF HEALTH 3 SETS OF PLANS SURVEY ................... CllECK .............. SEpTiC ~oR,~, . ;. ;. :2... 2. :. (Name and title of corporate officer) Plumber's License No ....... ~ ~..). ............ Electrician's License No .... .~.:.~?. ............. Other Trade's License No .... ~,/...~. ............ Location of land on which proposed work will be done ..... :~?~'.~... ~ ......... House ..................................................... Number Street ~' ~ ' ~;~;1;~'//;'~'' ................. " ....... .... .... ............ ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy .. ~'~ ......... ~ ~-~ ~:~,~tgS, g¢ ............. b. Intended use and occupancy ~~ ..... x,~,ht~.~,, ~ .... ,..~,...~} ......... 3. Nature ofwork (check which applicable): New Building .. ......... Addition .... ...... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Ot~er Work. (Description) 4. Estimated Cost , (to be paid on filing this application) 5. If dwelling, number of dwelling ulnits .............. Number of dwelling units on each floor ................ · If garage numberofcars ... 6 If business · · '" .................................................................. · , commercml or mixed loccupancy, ~pecify nature and extent of each type of use .................... 7. Dimensions of existing structuresI if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... !. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrffction: Front ............... Rear ............... Depth ............ ... Height Number of Stories 9. Size of lot: Front ............ l .......... Rear ...................... Depth ...................... 10. Date of Purchase...........j........,........ Name of Former Owner ........................... .. 11. Zone or use district in which premises are situated ..................... D°es pr°p°sed construction violate any zoning law, ordinance or regulation: ........ ........................ 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ,' Address · ' ' ' · ~ ................ Phone No Name of Architect ........... ' ................ Address ................... Phone No ........... ~ .... Name of Contractor .......... i ................ Address ................... Phone No ......... 15. Is this property within 3qO f&et of a tidal wetland? *Yes ........ No ......... · If yes, Southold Tqwn Trustees Permit may be required. .... PLOT DIAGRAM Locate clearly and distinctly all b~uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nnmber or description according to deed,/~nd show street names and indicate whether APPROVED AS NOTED [ - DATE: B.R #' NOTIFY BUILDING !AT ; 765-1802 9 AM TO 4 PM TIlE FOL-tOWING INSPECTIONS: i ' 1. FOUNDATION - TWO Ri FOR POURED CONCRETE 2, ROUGH ~ FRAMING & tMBING 3. tN~IJ[ ATtON i 4 FINAL COi'l,?l F!t. ICTIMU,ST / P,E COMPl,E1 E .... ALI,, COFISTHLICrlON MEET LO,~.:,, NOT FOR ~'dl~'~ '~'. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named· I ontrac gent, corporate officer, etc.) ................. f said owner or owners, and is duly aqth~rform or have performed the said work and to make and file this pplication; that all statemants containe¢ in this application are true to the best ofhls knowledge and belief; and that the 'ork will be performed in tile manner se[ forth in the application filed therewith. worn to before me this O tary Public n Qualified In 8uffo k County ~ (Signatur~ of applicant) Commission E~lres Oeaember 8~ 1~,,~/