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Home My WebLink About22114-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAU,. SOUTHOLD, N.Y. BUILDING PERMIT 22114 Z (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL o_o o ......................... Permission Is hereby granted to: .~....,........4..~...o.........?...~.~..~/~.... ~' ,o ...... ~..~~51~7~X ~ZE.~ ~~;~ .................. .......... ~..~~.... ~~z.....~.~ ......... ~..:~.~.~. ~.~.~.., ...... ............... ~ ........... ~.....~.~.~....~ .............. ~i ........................ L~ ................... $~o ~ ~-oo ~ X~-~ ~/ at premises located at ............................... ? ........................... ~ ....................."~ .................................... ............................................. .4./..~....~?~...,5:./..~./..,~. ........... ~:..~ ................................... CountyTax Map No. 1000 sectlon.....,Z../...~ ....... Block......<~... ................ Lot No. ...~, Z.-~ -/- 14, / pursuant to application dated ...... ..~...~.~......~....~...~... ............... 19...~....~......, and approved bythe Building Inspector. Fee $..."~F-~,. ......T ...... Rev. 6/30/80 20~.35 ! ! TOWN OF SOUTHOLD . !~~ . BUILDINGTowNDEPARTMENTHALL · SOUTHOLD, N.Y. 11971 BI.D~ D~PT. _ i TEL.: 765-1803 _TOWN I~ ~131J~lOU~ I~// .... , ....... lPfTPermit ..... ...... Disapproved a/c ..................................... ~uilding Inspector) ION FOR BUILDING'PERMIT BOARD OF HEALTH ......... /3 SETS OF PL,%NS .. /suRveY ......... '..:::::' ?c,lEc : ................... r ............. CALL ....... 7d~ ....... HA~TO: ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sgts 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 or areas, and giving a deta/led description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by tiffs 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all apphcable laws, ordinances, building code, housing cod. e, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect/.Ons. //. / J, . -- ~'"- ~ ~'~ '' (S{~natu(e of applicant, or name, ifa corporation! (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... ' ~lec,-i~,,~,, ~ Llccase No ....................... Location of land on which proposed work will be 'done .... ~. .... .~..~. .f. House Number St/~et _ Han~et County Tax ap I .... ..... ' .............. ' .............. :... Lot ............... Subdivision ........ . ............... . ....... j ..... '. 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 ......... 2 ................................................ ..... b. Intended use and occupancy ..................... · ................ - ............................... -3. Nature of work (check which applicable): New Building .......... Addition... · ,-.---~-----' ,,i, ~ ;4.1le~-atio~ ....... ' Repair ............. Removal .............. Demolition .... : ......... Other Work. · ,'f~.~.~..~w. '~] ~'-'~./~ ~ t).:~.~ ~' .... ' ' ~ (Description) 4. Estimated Cost . Fee .................................... (to be ~~s application) 5. If dwelling, number of dwelling units ............... Number or dwelling unit's 'b~ ............. . If garage, n~mber of c~s ...................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of.ca~h type of use ........... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth . ~r 'j · · · Height ............... Number of Stories ....................................................... Dimensions of shine structure with alterations or additions: Front ................. Rear ................. Depth .... ~ .................. ttei~t ....... } ...' ........... Number of Stories ......... s. 2 ........ ,~-8. Dimensions of entire new construction: Front ........... Rear .............. D~pth ~. ~ .{.0~ ~ . Height ............... Numbe%of Stores 10. Date of Purchase .................... · ......... Name of Fo~er Owner ............................ 1 I. Zone or use district in which premises are situated ............................................. ~ ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ....... ; .................... Will excess fill be removed from premises: Yes N( 14. N~e of Owner of premises .................... Address ................... Phone No ............... N~e of Architect ......... . ............. ' .....Address ................... Phone No ................ N~e of Contractor .......................... Address ............ ; ...... Phone No .......... ; .'... 15.' I~ this property within 300 feet of a tidal wetland? *Yes ........ No ......... : · If yes, Southold Town Trustees Permit may be required. .. PLOT DIAG~ Locate clearly ~d distinctly ~1 build~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions fro~ prope~y Hnes. Give street ~d block number or desc~ption accord~g to deed, and show street nines and indicate whethm .' 1; FOUNDATION -. TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ~hSULATION 4. FiliAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF ~HE N,Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUC[ION ERRORS STATE OF NEW Yc~K~ I }~-q ~ COUNT¥ y .... ! 5, )7 ' ....... ...... (Name of individual signing contra t) above nanmd. .... being duly sworn, deposes and says that he is the applicant He is the .................................. ...~ ................................ · .............. ' (Contract~, agent,~or'porate officer, etc.) . of said owner or owners, and is duly authorized to peTf~r-m~r have performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. '.:7.: ..... ~m~ion