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Home My WebLink About22142-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] 22142 Z ......................................... ~c~.~'tA~....( 2..., ......... ~..ff. .:.,Y.., :. ........................................... Couniy Tax Map No. 1000 Section ...... ...~.....?. ........ Block ........ .~ ............ LotNo. /.. ....................... ' pursuant to applicatlon dated ........ ~...~.....~.....,.~.. .......... 7, ......... 19.~..~.. ...... and approved bythe Building Inspector, ~ee~..~.~.. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~~ ~ SOUTHOLD, N.Y. 11971 _ OWNOF~( ~T~OLp..,~ TEL.: 765-'1802 Disapproved a/c ..................................... I/LIcATIoN FOR BUILDING PERMIT BOARD OF HEALTH . //~5URVEY ......... ~/CIIECK .......... /SEPTIC FORH .... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 shts 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 pr 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for tlie 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 inspections. ~ ' ~Z~ ~ ! State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· APPJiO D AS NOTED , / (Name and title of corporate officer) ~//'~tr/~'" # "~:"*'~- ~-- .Builder's License No.. NOTIFY BUILDING DEP~ENT AT ........................ 765-1802 9 AM 10 4~;PM FOR THE Plumber's License No ......................... FOLLOWING INSPECTIONS: I, FOUNDATION - TWO REQUIRED · · , FOR POURED CONCRETE Electric an s Lmense No ....................... 2. ROUGH - FRAMING & PLUMBING 3. INSULATION Other Trade's License No ...................... 4.. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O.. 1. Locati,on of land on which proposed work will be done ................... ,a, bL..CONSTRUCTION. SHALL, .MEET.. ........................... . ............... ' ......'8:rAq~Ls.x~°ONST. RUC'rioN · &, ~I~RG¥... House Number Street OttlBffl~t NOT RESPONBtBLE FOR _ DmGN OR CONSmUCmON ERRORS County Tax Map No. I000 Section ...................~}~ Block ..... O..~>.. .......... Lot .... /. ?...' .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ~. f) ~.~.. CLCt~ .I ................................................ b. Intended use and occupancy ...~..~.[~.~.e__~ ' property lines. Give street and blockinumber or interior or coruer lot. 3. Nature of work (check which applicable): New Building . Addition ...... .. ;~, ~.~t,~n2~. ~l ..... 4. Estimated Cost ........ · i (to be paid on fi~,~,[hJ~,lication) 5 Ifd fa g N ~1~ .... · welhng, number o wellin units ............... umber of dwelling units on ea tJ~b ~. ............. Ifg · arage, number of cars ..., ............................. 6 Ifb m'~d ify t,u. .............. f' ........................ · usiness, commcrcial or lxe occupancy, spec na re and extent of each type o use .................. Di i f .... 7. mens OhS of existing structu es, if any: Front ......... Rear ...... De ...... . .. H igl mb fsi .............. pth ...... e it ............... Nu er o cries ..................... Dimensions of same structure with alterations or additions: Front .... 2 .......... Rear ................. Depth , ..... ~q' · ............... i ' · · nmgnt ...................... umber of Stories ...................... 8. Dimensions of entire new cons[ruction: Front ............... Rear ............... Depth ...... ~ ........ Height ............... Nu[nber of Stories ........................... 9. Size of lot: Front ...................... Rear... De 10. Date of Purchase ........ ................. pth ...................... · .' .......... ......... Name of Former Owner ............... I 1. Zone or use district in which premises are situated ....... ' ............. 12 Does p opos d eonst tic vi61 oningla dina fV.O ................. · r e ruc n ate any z w, or nce or re,ulation. . ............ 13 Willl t her graded i ...... °~ . ' ................. 14' N o e ....... ~ .................... wm excess nu ye removed from premises: Yes No · amc of Owner of premises .. ! ............ Address ' N of A 1 itect ......................... Phone No ................ Naan~e rc ~ ......... i ............... Address ................... Phone No ................ e of Contractor ........ : ............ ; :'.. Address .. ................... Phone No. 15. Is this property within !300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold iTown Trustees Permit mgy be reqr~ired. PLOT DIAGRAM Locate clearly and distinctly nl1 buildings, whether existing or proposed, and, indicate all set-back dimensions from description according to deed, and show street names and indicate whether STATE OF NEW YOR~K,' ' ~.S COUNTY'OF . '~', . ..... ~.C-.~. 9..C- .... ~ ,. 3. 'l 0 ................ being duly sworn, deposes and says that he is the applicant (Name of individual ' ' s gmgg contract) above nafned. He is the : '. : ~ (Contractor, agent, corporate officer, etc.) of said Owner or owners, ~d is duly'authorized to nerfom a . ,. ~ .~ . . ~ ~. have perfomed the'said work and to m~e and file this pphcatmn; lhat all statements contained m thru application are true to the best of his ~owledge and belief; and that th~ work W~i be perfoflned in the m~ner ~et forth in the application filed therewith· Sworn to before me this Nota~ ~ublic .......... ~.~~ . ':2- ........., ..... County UNDA J. COOPER N~a~ Public, S~of N~Yo~ (Signatu~ of applicant) - NO. 4~563, Surfak ~u~