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Home My WebLink About22418-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST NTIL FULL N.O 22418 Ooun~,Tox,apNo. ~000 Seo,,on ...... ~.~ ....... B,ook.....~ ................ LotNo...~ .................... pursuant to application doted .......... ~..~.../.~....... .......... 19..c~.....~...... and approved bythe Buildll~l~nspector. Foe $....~,.~,,,1~), ............ Rev. 6/30/80 ~'IDATIO{! ' ' ' (2nd) ;H FR~HE &.. : CODE [O})AL C O.MN E] Examin FORM NO. 1 OF SOUTHOLD G DEPARTMENT HALL D, N.Y. 11971 BOARD 0F HEALrlt ......... OURVEY ........... ¢~CIlECK ............. SEPTIC FORH ....... HAIL TO: (Building Inspector) _ICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be compleD.ly 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. ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 ~hail be kept on the premises available for inspection throughout the work. 5~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occppancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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. .. P. 0.~..-c .... oF.....e:C.-:.~.e..r.....e~..r-../.q..c... -" (Signature of applicant, or name, if a corporation). ·..m...~t.~.. gO....~a.~~ .:,. ~/ .... (Mailing address of applicant) /[~ "7 / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... 0.~.~ ~._~. ....... ~..,Z.....~.,~.,¢. ~ Name of owner of premises ..... ~. ~S... ~~...~.. ~ ~<Q ....................... (as on the tax roll or latest deed) If applicant is a~orporation,,signat~e ~f~ulv autborize~ficer. (Name and title of co,orate officer) Builder's License No.. ~..~-f.~.~ .~ Plumber's License No ........ : ................ Electrician's License No ....................... Other Trade's License No., .<' ....... 1. Location of land on which proposed work will be done... 7".w~'[~~~ ~ ~W ....... House Number Street Hamlet County Tax Map No. 1000 Section ... ~ Block .... -,-~:%-~,~. ~ Lot .~..~ Subdivision ........ (Name) Filed Map No., Lot 2. State existing use and o'ccupaney of premises an&'intende~ use and occupancy of proposed construction: a. Existing use and occupancy' .... . ' ..................... %~{ ~,,, t[~,,,,~9 ..... ,''~.. b. d d Intende use an occupancy ..................................................... , ...... ~...,., 3. Natur, e ofwo, rk c~ieff~which app)icable): New Building .......... Addition .......... Alteration ...... Repar ... s~. ......... Remogal ............. Demolition .............. Other Work .............. .~./.~>.---~..C~. ' ·,, (Description) 4. Estimated Cost Fee ......................... ~ (to be paid on filing this application) 5. Ifdwelling, number of dwelling u~its .. . Num e o w ngunitsoneac eot ............ · If garage, number of cars ...... i... ii ............ : ...... 6. If business, commercial or mixed Occupancy, specify na'iure and extent of each tyne of use ' ~,~..~". 7. Dimensions of exjs~ng structures,i if any: Front ~;~.'/:? ...... Rear . .c~[.~..g ' . 'D;n/h ' ~,~t'~ 't ...... Height ...... /~.~. ..... Number of Stories .... ; .~ ............... i.. ' "i. ' ................. ' Dimensions of s,ame structure with alterations or additions: Front ..... 0-~"~4. ........ Re r ..... ~Depth .. .... ~,.(<17 .......... i. Height ..... ]8 .... ~,.~ ........ Num~;r of Stories ...... .~...~. ~'i. 8. l,~imenmons or entire new construCtion: Front ....... ~.~.... Rear ............... Depth ............. ~eight .............. . ,~cal~r of Stories , , ~ . . 9. Size of lot: Front ...... .~',.~;~ ......... Rear ...... ~ .b~.(~q~i '. i'iiii'l~'e'vil~ .... /~$'~.. '~."i '. 10. Date of Purch.ase.... ..... f.~'. ,c~..~:> ..... , ......... Name ofVorme'r O~vner ...~. ~.'.~.' .~.' i ~..~7.. 1 1. Zone or use district in which premises are situated... /?]...Z~. ................. 12. D.o. es proposed construction violate'any zoning law, ordinance or regulation: . ,~.' ~i i i i. iiiiiii. 13. Will lot be regraded ....... -'," i" '/~'~' .......... Will excess fill be renloved from premises:~/~ Yes No 14, Name of Owner of premis,~ ~..C~..~x-/9~..~.ff_.~/~..~.. Address rf~,,V.~... ~,/~'.,~,..~.~.F./f.q'qq. Phone Name of Architect .... ~ ~r.g,~'._'7'~/~.. · ~.~.6'Address/~at'.'~. ,/.~'~ -~.. ~.w~.d~.~.~ Phone No-.gfiz(; Name of Contractor.. I~. ~..~-... ~D~/~..i~. /. · ./'J~?-~. Address .,~'.',~/~,'/f).i i ~r;,~a' vh,,,~ ~, ti. Is this property within 300 feet of a tidal wecla'n'd?'' ;'Ye's.'.'.~¥'.'.¥ 'N'o'i~'i~ :'.~.'.'~. ............... · If yes, Southold To Locate Clearly and distinctly all b property lines. Give street and block nu interior or corner lot. ~n Trustees Permit may be required. PLOT DIAGRA~ dldings, whether existing.or proposed, and, indicate M1 set-back dimensi6ns from :nber or description according to deed, and show street names and indicate whether ,TATE OF NEW~YO~K, , :OUNTY OF .~.f.r~a.c..~--;,. S.Si ............ .~, ,./T. ............ being duly sworn, deposes an~says that he is the applicant (Name of individual signing Iontract) hove named. is the ' ' (Contractor, agen{, corporate officer, etc.) said owner or owners, and is duly aqthorized to perform or have p~rformed the ,said work and to re.eke and file this )plication; that all statements containe,~ in this applicati.on are tru% to the best of his knowledge and behef; and that the ork will be performed in the manner set, forth in the application filed therewith. ,yom to before me tllis, ........... /3~.].~...;dayo(..~..~ .... ,1~. . NOtllly Publlo. State of Nev~ Tom ....... ' No. 4879505 r ~--- ~ 'Si n { g ature of applicant) Qualified in 8uffolk County