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Home My WebLink About22202-zr FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUIHOLD, N.Y. No- 22202 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .................... ~.~.. .......................... ] 9, ../~......~. Permission Is hereby granted to: \ .............. ], ..... t o....~,~.~.~ ........... /2.. ............ ...,~.~.,~...~ ......... --/.~.~......i.x..~ ...... ../..~.¢,~..~ ............. Counh/TaxMap No. 1000 Section.......~......' ....... Block ...... ~ .,~.... ...... ;. Lot No......~.....~.. ............. i. pursuant to application dated ................. .~.~./... ................. ............ 19....~.'.~..., Building Inspector. '~ee,.....3.~:,~ ..... and approved b~ the Rev. 6/30/80 8LDG, DEP'Ii TO~ SOUTHOLD ~ ^pproved ..... 2/.? l¢ Disapproved a/c ............. . ......... ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (~ il~g Inspector) APPLICATION FOIl BUILDING B~ARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK ........ · . Date ................... 19... ' INSTRUCTIONS a. This apl~lication must be completely 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 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 Southold, -Suffolk County, New York, and other applicable Laws, Ordinances or Regulation.s, 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 inspectom on premises and in building for necessary inspections. ~_ (Signature of~n[, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of premises .... }.. ~.~... , t ': Oq3~ ~ (as ~n the ~ax roll or latest deed)' I ....... ~1"'"~ ~ ' - ~' _ If applicant is a corporation, signature of duly authorized officer. DA~: ~~P.' .............................................. (Name and title of co,orate officer) : NO~I~ BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE Builder's License No .......................... FOLLOWING INSPE~IONS: Plumber's License No. * 1.. FOUNDATION -~ ~O REQUIRED FOR POURED CONCRETE,' 2, ROUGH - FRAMING~ &'PLUMalNG Electrician's License No ....................... 3. INSU~TION 4.. FINAL - CONSTRUCTION MUST Other Trade's License No ...................... BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET 1. Location o~land on which proposed work will be ~onc .......... ' THE REQUIREMENTS OF ~HE N.Y~ ......................... . 0 Itouse Number Street Hamlet Cou'nty Tax Map No. 1000 Section ..... .__.¢ ..... Block ...... ...... 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 ~.~~ ......... b. Intended us= and occupancy 7 -3. ature of work (check which apphcable): New Building . ~ ........ Addition...' ....... Alteration ....... }.. Repair .............. Rer~oval .............. Demolition .. : ...... Othr Work~...,.~'.~..C~--~.. · O ~Bescmptlon) 4. Estimated Cost O ........ :'; ....................... Fee ~ C90 · . ~ . (i ' gth' ppli ' */' o be paid on fihn ~s a cation) 5"1~ gd:~lgl~,ngn'unmU2br ;rf;fardsWel.~/~umt~ .~.. ~. ~ ......... . .Number of d.wellin, g..uni, t: .on. each. fl.o.or .,~../...~.. ..... 6. If business, commercial or mi.xe:d occupancy specify ~ature and extent of,each type of use. ~..' '/.~.... 7. Dimensions of existing structur s, ifany: Front ......... Rear .............. Depth igh t in b He ...... Nu er of Stories ..................... Dimensions of shine structure w:ith alterations or additions: Front ................. Rear .................. Depth .... ] ............... 4 · Height ........... . ....... . Number of Stories . 8. Dimensions. or_entire new construction. Frnnt /OO t '~' ' __..._, ........... ~ ......... u~'o,., ~.~ ,~.,~,~... ~ ................. Rear ......... DeBth zL;lont. .7. ;r,q*~q. ....... Number of Stnrie~ ~ ' ..... '- ............ · t /O ................. 9. S~zeoflot' Fron o . ,. '~',~ ......... , ..................... , ....... .......... Rear .... :×..e ............ Depth 10. Date of Purchase .. .......... i ......... ' ......... Name of Former Owner ................. 11. Zone or use district in which pr mists are situated ................ ; ..... ' .... · · ' · 12. Does proposed construction violhte any Znnine, I~,~, ,~A' ' · · .,,'1,~,O ........ , .... i ........ o .~-, ,~,4nance or regulation: . ./.~. ? ..... 13. wm lot t~e regraoecl . .,(~.9;. . . , ......... ' .... 14. Name of O ....... ~ _ · DJ-'A ' 'a_' i.'.~.',: 'A'.' · ',~ .... mu ex,ss nu oe removed from premises: Yes ~ I'4r~ . ~-~* u, premmes r.~ LtC.j.lll4..o~.¥~.~t/~.~[,-~ Address .~..~xA~. ~>~-l- ,-- Name of Architect ! ' ' d _,, · .... u. · .~ ........ rhone mo. v/. t..t ..... ;... ......................... ,~aaress ................... Phone No ............. .. Name of Contractor ......... i . . . Address ... .. Phone No ............ ' .... 15.' I.s this property within ~00' 'f~t of a tidal wetland? *Yes ........ No ......... *If yes,~Southold :own Trustees Permit may be required. .... ] PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~o~$,ff~...~~ S; COUNTY OF, .~-~,~,..,....~' [ . (Name of individual signingIcontract) tbove named. {eisthe ', ~ ~~~ " · (Contractor, agent, corporate officer, etc.) ' f said owner or owners, ~d is. duly ~ ' ' ' aethonzed to perform or have perfomed the said work and to m~e and file this pplication; that all statements containe]d ~ this application are true to the best of his knowledge and belief; and that the /ork will be perfomed in the m~ner se~ forth in the application filed therewith. worn to before me this ~ .......... ota Public[ _ 'CoJn't ~ ~DAM.~NYE8 I ~ - . ........ ~--~/~/ ........ ~PublIo, SI~N~Y~ ~ ~ , ~ ~gnat~e ofapplic~t) ' ~ 4~2~, 8~o~ ~ ~ ,. , 6 ~:w~O0 w ~ Z b. zd Z mZ z ~ i,u w u ~: