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Home My WebLink About22285-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES {JNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..................................... 22285 Z CouniyTox Mop No, 1000 Section ....... .~.....~...,~.~.,,,, Block .......... Z ........... Lot No.......~....C.~ ......... pursuant to application dated ........ .~...,~..~,. ..................................... 19..~, and approved by the Building Inspector. Rev. 6/30/80 NOTE: I. ~ = STAKE 2. SUFFCX-K COUNTY TAX MAP DIST I000 SECT 107 BLK I LOT P/O ;~ 5 SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERKOFSUFFOLK COUNTY ON MARCH 25, 1992 AS FILE NO 9203. SURVEY FOR DENNIS A. SCHRADER'8~ WILLIAM d. SMITH LOT NO. 3, "MATTITUCK CREEK ESTATES" AT MATTITUCK TOM/N OF SOUTHOLD SUFFOLK COUNTY~ NEW YORK CERTIFIED TO: DENNIS A SCH WILLIAM d Si~ NORSTAR MOt PECON,~ Examiued . ... ....., 19 .. ' / Disapproved a/c ..................................... ~ · . (Building Inspector) APPLICATION FOR BUILDING PEHMIT FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. '1'~971 TEL.: 765-1802 B~ARD OF HEALTH SETS OF PLA~{S fSURVEY ....... CALL ~ ............. HAIL TO: INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Sttsl~f plans, accurate plot plan to scale. Fee ~ccording to schedule. · · Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sfi'eets or areas, and giving a detailed description of layout of property mu~t 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 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 Cer/ificate of Occupancy shall have been granted l?y 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., a,~ reguiati.~(ns, and to admit authorized inspectors on premises and in building for necessary inspectiolzs. ! ,y// .,,//f / . ' . (Signature oXf'applicant,~r n-aJr(e, if a corporation) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. .. O. .................... ' · . N~ne of owner of premises -~(/~.~g'x..~.'..~./(~O ~ ~'/~. ............. (.~.Z~.~.~..~/~ .C~..~. t6Jt~t~?.Ary. (as on the tax roll or latest deed) ' ' If applicant is a corporation, signature of duly authorized officer.' ' (Name and title of coiZporate officer) Builder'I License No ........ ff..~.~. ............ Plumber s yicense No ....... '..d~.'///~./~ ............ Electrician s License No ..... .,.~/./,,(j.. .... . ....... Other Trade's License No .... .,~/.~.L ........... Location of land on which proposed work will be done ......................... ; ....... : .......... /g.o.O. ' Itouse Number Street Hamlet County Tax Map No. I000 Section :... ;./~..~. ....... Block ...... /. ........... Lot ............. Subdivision .~/~.7~'~.6]~..6/~.~1.~ .~]-~[.~.~...'. Filed Map No..~o~.O. g .... Lot .3. (Name) .... : ........ State existing use and occupancy of premises and iutended use and occupancy of proposed construction: b. Intended use and occupancy ... . ...... · .... ';". , ~.~., (check whlch:apphcable): New Building ......... Repair .............. Rcnoval ............ Demolition ' Addition .......... 7:d'terahon . J~ ..... · ' ' ....; .... Other Work. ~.~,~., , 4. Estimated Cost t · (Description) (to be paid on fil~Bge~.hla.:appliaation) 5. If dwelling, number of dwetlir g units Number of dwelling units ou each floor ..... Ifg ............... · arage, numberofcars ...~ .... . ......... 6 If b i mi~ d ' rci 1 ify t d ........................................ 7' Di us ness, comme a or . e occupancy, spec na nrc an extent of.each e ..... i sol' iti gstru fires, if F typ ofuse · mens on ex s n ct any: rent. ' ............. Hight N 'mb .............. Rear ......... Depth ' of Sto les ... ~ .... ' ..... of sam } th Itc dd :F ..... ~ .......................... Dimensions e structur,, vl a rations or a irons rent ...... Depth .... } .............. i ' ' ' Height ........ · ................. Rear ......... 8. Dimensions of entire new construction: Front ..... · . · ~eloht ............... .Number or Stories ....... t'i't"' Rear ............... Depth .... Date of Purchase ...~'LI.~'ia IJ~qa'k. ..... ' ........ D.~epth . a~O.O ............ 11. Zone or use district in-which p~i~es are sit;~idt~'' e Ow,er . 2a ,.,.o,,es proposed construction ymlate any zoning law, ordinal; ........ ' ' "; 'Dfi ...................... '13. wm lot be reeraded A/t7 .... ~gmauon: .... ,z~w. .......... 14. Name of Owner ofpremmes .{&)l[~ ~q,x t~-, ~,~[5,~ ...... ~II .b.?,,r, em~ o/ed from premises. ~ Yes ("~ ~ame ot~zontractor . .t///fT. , ,,, · ............. one e~o ............ :.... I.s thx~.s property wxthin i300 feet of a tidal wetland? ' ,;- ........... .~hone No .............. .. · ',If yes,'Southold ~own Trustees Permit may be ro~x'es'~ ...... "-. i PLOT DIAGRAM Locate clearly and distinctly alll buildings, ~heth~r existing or Proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. ;TATE OF NEW YORK, ~OUNTy OF . S.~ (Name of individual signing ., ........... being duly sworn, depose~ and says that he is the applicant · contract) bore named .... ~ is the ' ~ " ' i (Contractor corporat~ ...................... ' ~ agent officer otc ) ............... said owner or owners, and' i~ duly 4ufi~orized to perform or have performed the said work and to make and file this ~plication; that all statements cents'ned in this application are true to the best o~'his knowledge and belief; and that the ork will be performed n the manner s~t-Tort i n the application filed therewith. .yom to before me this .i