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Home My WebLink About22196-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, N.Y. 22196 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) Permission Is hereby granted to: .... ~L/.../..,.~....~...~.,. ~..... ~..~~ ............ ~~.~ ......... ~..y......../.~.~ :~./. ......... .,/..~. ,~/.¥~ ........ ./.~.: ....................................................................... ............. at premises located at ..................... ~ .................................................. : ..................................... Counly Tax Map No. 1000 Section....Z..~... ........... Block ......... .~...~.,. ....... LotNo ....... Z ................ pursuant ,o application dated ................... ~,,~,....~,,.~...' .................... 19,.. ,~., .~..,.., end approved by the Building Inspector, Eee S...~,,.'..~ ...... jdinginspector Rev. 6/30/80 ~, ' FORM NO. 1 ![ t : BUILDING DEPARTMENT ,:Li TOWN HALL ~ SOUTHOLD, N.Y. 1197~1 L ~°~i~l:s°uw~u' ' TEL.: 765-1803 Examined ..... . .... , 19 ^pproved ....... ?// , 1,? e it No. / Disapproved a/c ..................... · (~i~g Inspector) APPLICATION FOR BUILDING PERMIT B0X~D or aZALra ......... 3 SETS OF PLANS SURVEY ................... ClIECK ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~ts 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 st?eets qr 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 i~sued 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 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 author/zed inspectors on premises and in building for necessary inspectio,n.s. -- (Signature of applicant or name if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 'plumber or builder. .................. :...,..: ................................. L NmO: ..... NOTIFY SUILDINO DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 S AM TO 4 PM FOR THE (Name and title of corporate officer) : Builder's License No .......................... Plumber's License No ......................... FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING $. INSULATION 4. FINAL - cONBtRUG~ION 'BE COMPLETE FOR:C.O~ ALL CONSTRUCTION SHALL MEET Electrician's License No. ' THE REQUIREMENTS OF THE N.Y. ,,,,, ............... · ....... . STATE CONSTRUCTION & Other Trade's License No ...................... ~ ,~,~z/~ CODES. NOT RESPONSIBLE, F~i~: Location of land on which proposed work will be done..~...¢~..~.q.(~(.. :~ ~(:..'.,...'. I Street Hamlet County Tax ~ap No. 1000 Section '... :..'~. ' ~ . ........... :.: ......... .... Subdivision ........ . ................... . ......... '. Filed Map No ............... Lot ............... (Name) Statd existing use ~nd occupancy of premises~ and inte~~us~ an~ o~cupancy of proposed ~onstruction: .... .... .......... ........ · 3. Nature of work (check which Repair .. . -4. Estimated Cost ..... tpPlicable): New Building .......... Addition A~lt'eratmn ...... royal .............. Demolition .... : .......... Other Work ?~.~..~..~-~.. .... f (Description) ' (to be paid on ~i~F~l~Ii~al;ion) 5 If dw lli be f d elling its Numb of d ........ ;~'.;~u~,~t.~?~!-n~v,~. - . eng, num r o w un .............. , er welling units on each floor. . If garage, number of cars .... ~. .................. ' ............... 6 ~bus' yss ci lo ix~do ffyn reand tentof I . ' .......... · in , commer a r m. ccupancy, spec atu ex ,eacl tyne of use 7. ~mensmns' of existing stmctu*es if any' Front ~- -- '-' ' ~ ............... ..... [ ~ ............... lx~ar .......... ~eptn ....... ne~gnt ............... Number of Stories ....... ' ........ D fshm With lte ti dditi F ......... ~J ......... ; ....... l~enslo~S o e structure a ra OhS or a ons ront ~?th ' H i~t .................................... 8 ~ .... ~ ................. e ........... . ........ ,.. Number of Stories .......... ~ ...... . ~mens ons olentire new construction: Front .............. ; Rear ............... Depth Hight N ~b f Sto les ............... e ............... u er o r ..... . .......... 9 Si eofl Fr t ' Re ........ ' ................................ . z or: on ......... .. ~ ..... ' ..... ar .................. Depth 10 Dar ofP cl . ...................... . e ur iasc .......... ; ................... Name of Fomer Owner ....................... 11. Zone or use district in which piemises are situated 12 o: ........ ' ....................................." ' '.' " '' ' . . Does proposed construction vi late ang zoning law, ordinance or regulation: ........................ 13. Will lot be regraded ....... ; ~ ................... Will excess fill be removed from premises: Yes No 14 Nmne of Owner of premises ' · .......... , ........ Address ................... Phone No ............ :... N bite me of Arc ct . ' ........ ; ................ Address ................... Phone No ................ Nme of Contractor '.......~ ..... ............ Address ........... . ' ...... PhoneNo ....... ..... '., i5.' 19 this property within ~00 feet of a tidal wetland? *Yes ........ No ......... · If yes, Sou~hold ~own, Trustees Permie may be required. .. ~' PLOT DIAG~ Locate clearly ~d distinctly fili bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from property ~nes. Give street and block :number or description accord~g to deed, and show street nines and indicate whether ~tefior or corner lot. being duly sworn, depose~ and says that he is the applicant ,., ~', ~ (Name of individ,¥al.,iigni,I}'g contract) ] . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly iauthorized to perform or have performed the said work and to'make and file this application; that all statcments contaihed in this application are true to the best of his knowledge and belief and that the work will be performed in the manner ~et forth in the application flied therewith. Sworn to before me thi~.. ~o. 4879506 ~ , . v i n '