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Home My WebLink About22297-z FORM NO.3 TO~I OF $OUTHoLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-° 22297 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ... ~ ~, ~~.,. ~-.. ~ ~/.,. ~ ............... ...../.~ ....... ~.,.~ ................................... ...... ~.~....-~...~.-..~z~ ......... ~..~,...~ .......................... ~o...~..~...~.~ ...... ~ ........ ~..~..........~.J...~ ....... ~......~... ........................ Building Inspector. Fee $.... ,.?..."'~'..'. ~ ..... and approved by the Rev. 6/30/80 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND ~~11~.~ [ ] FRAMING / [//] FINAL [ ] FIREPLACE &/CHIMNEY'-~ / FEE: ~O'~ .... BY:. ............... NOTIFY--BUILDING- T AT 765-~802 9 AM TO 4 ,,, FOR THE 1. FOUNDATION - TW~ REQUIRED ' FOR POURED CONCR~E .................................... ALI;-CONSTRU'8'TIoN- THE BEQUIREMENTS THE. N.Y. STATE ENERGY CODES. NOT JlBLE FOR DESIGN OR E~RORS DR/VE CEDA RFIEL DS ,~o . MAP OF FLE~:TWOOO UIIDATI'ON ".'."({st) JI~DATION ' f2nd) ". I1 :UL,ATTON PER ~. Yo II STATE ENERGY II CODE 'FINAL ' ' ADDITIONAL COM~IENTS: : .I tff~DERWRITER$ CERTIFICATE hr~Ull~l'U ~_DCUPANCY OR APP]IOVED AS NO'I~D FEE: - /' '" BY: -~-' ' NOTIFY BUILDING DEPARTMENT ET .......- g ~,.,"" TO 4 ~ FOR ~u=..._ F,'~. ' '"' USE IS UNLAWFUL ?. oo¢. r,, ,~ f~=c_~__~ ~/_ WITHOUT CERTIFICATE ~ , -~- ~ OCCUPANCY FOLLOWING INSPECTIONS:, !_ 'FOUN_rt&T!ON - TUMO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST, BE COMPLEIE'~j~R ALL CONSTRU,~TJON SHALL MEET r T~E REOUm~UENTS ~ :i?~i'?,'~.''~ ' STATE CONSTRUCTION i& ENlaRge,' .:, '-';"~'7',;~':-:?'-:",.., ' - CODES. NOT RESPONS'iBLE F~,~ BLDG DEPT TOWN OF SOUTHOLD Disapproved. a/c ..................................... FORM NO. 1 TOWN OF SOUTNOLD BUtLD[NG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 · (j il Inspector) APPLICATION FOR BUILDING PERMIT B~3AgD OF IIEALTH ........ ~/3 SETS OF' PLANS ........ ~/~cURV£Y ..... llCC~ '''.''''''' SEPTIC f 0 R,'I ............ CALL ....... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with f 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 sfi'eet~ or_ areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli ;,,,, c. ' The work covered by this application may not be commenced before issuance of Buflaing Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi~ shall be kept on the premises available for inspection througi~out the work. .-. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancx 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~,b-tl~ding code, h~using code, a~l regulations, and to admit authorized inspectors on premises and.in b~ilding for necessa, drfJhsp~ ~ ~ ~ ~ .~ ~' ' . (" '~; '~" :~~(-Sign~ture of applicant, pr name, if a corpo&atio.n)''' (Mailing address of applicant) State whether applicant is owner, lessee,, agent, architect, engineer, generai.'contractor, electrician, plumber or builder. -- (as on the tax roll or latest deed) ' ' If applicant is a corporation, signature of duly authorized officer. ; (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ............ Location of land on which proposed work will be done· ...... ........ [-louse Nmnber Street Hamlet County Tax Map No. 1000 Section (..~. ~ .......... Block ...... ............. 7.9 d & ...... ' (Name) ' ............... State existing use and occupancy o[ premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy ..... ~~ ........................................................ b. Intended Use and occupancy ~ ' · 3. Nature ofwol'k (check which PPlicab e), New Building . · . , .............. Removal ..... ~ . 4. Estimated Cost ...... ' - (Description) Fcc ~ [ · (to be paid on filing this application) 5. If dwelling, number ofdwellin units ............... Number of dwelling units on each floor ........ · If garage, number of cars ~ 6. If business, commercial or mixed occu-a.,c,, ~,,, r,, ~ , ,-' · ' j ~' ,' ~,~, ..... :nat_.~ureanaextcntofcac t eof 7. t~unens~ons ot existing structures :c_ . . -~ --, , ~1t %P use , .,..,:.. ........ . .eight ......"~Q ........ Number of Stories ..... 7, r r ....5.1 .t~ ...... Depth ..~...gA'.,.~.. u~uuo,~ or auamons Front . _,a.t~tl~b ~ 8. Dmmnsmns of entire new construe[i^,, ~ .... , ' ~, ,~ ti, ..... Number of Stones .... C-, ...... ' ...... nmght ..... ~ · · .~ · Nufl~ber of Stories ,~_ · · · ear .... .m..~,.q ..... Depth . .~..tt.) ........ 9. Size oflot: Front . . ;/-T' ~. . ',~ ........~'"a' ;2- ........ , ..................... I0. DateofPurchase . '~'~.t~O Ill t~'/ ~; ....~fl, d ........... Depth ...~.~.~ ...... .... , ......-'. ............ marne of Vormer Owner ......................... I1. Zone oru~e district in xvbich ' ' · . ................ '.. pr,emlses are situated.. 12. Does proposed construction rio:late any zoning law, ordinar~ce or regulation: ... i'd' ."O .................... 13. Will 16t be reo-raded Vq O N .... · ..... '": .... D ~' '_'d, '[]: .... Will excess l;ill be rem dyed fr,,o~ premises: Yes__/ NE 14. ama of Owner of premises . .,,%'4q-q~..~. 2.. Address .t..F..6.O..~./5(4/~. i]hone No. N ' arne of Architect ..... y .. ' .... tx Name of Contractor . . -~' ............. aoeress ...... ~ ............ Phone No ..... .'5,. ...... · ~ -- ' ...... '* ................ Address ...... .'i ......... Phone No ..... ~.~ .... '. 15. ~.s t~is property within BO0 feet of a tidal wetland? ~'~ ' ~ . · *If yes, Southold Town Trustee- ~ ...... =~ ........ ~o..~v~..... ~ rurra2, c may De required. '' i. PLOT DIAGIL4M Locate clearly and distinct! J · ' ' ' . ' · . Y allI bmtdmgs, whether existing or pro osed d,' ' ' . property lines. Give street and block number or &,~,-,4.,~;,-,,, - ..... .P , . a~, . indicate all set-back dnn enslons from interior or corner lot , - ..... ~ ..... accorumg to oeea, ann snow street names and indicate whether STATE OF NEW :outcry ...... , .............. : ........... J' - ~ · [ ............... being duly sworn, deposes ~d says that he is the applicant (Name of individual signin' contract) ,bore named. {els the ' (Con tractor ........................ ' ..... ' agent '1 orate officer etc ) .......... f said owner or owners, and is duly mthorized to perform or have perfoHned the said work and to make and file this · plication; that all statements contain':d ork will be perfo~ed in the manner s~t Yorth in the application filed t ~erewith. ' a'om to before me this~ ~ .