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Home My WebLink About21967-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL' COMPLETION OF THE WORK AUTHORIZED) Date .................. ~./.2~ ........................... 21967 Z .................................................................................... ~,~.~...~./~...~ ............................ County Tax Map No. 1000 Sectlon.,..,~.,/,.~..../. ..... Block ...... ~.~. ............. LotN' o ....... .~..~...~..,. ......... pursuantto application dated ........ ~./~.~,~.....~.../ ................... 19.,...¢.~.,.., and approved bythe Building Inspector. .......... ' ng nspector Rev. 6/30/80 Examined ......... , 19. Approved .... 3/.o~. ~ ..... 107.~. Permit No...o.~.( ?..~. ~ ~ Disapproved a/e ......... : ........................... · FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 · (/Dfl~ng IaSspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALI'It ......... 3 SETS OF PLAr~S ......... SURVEY ............. ,.... Ei, c .; ........ SEPTIC OR,'I ........ MAlL TO: a. Tiffs applicati°n must be completely filled in by typewriter or i~ ink and submitted to the Building inspector, with 3 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. e. The work covered by this application may not be commenced before issuance of Building Per,it. 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 grauted 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 agree~ to comply with all applicable laws, ordinances, building code, housing code, and regbtations, and to admit authorized inspectors on premises and in building for nec~_~j:a~s. - -- ....................... (Signature of/~pplicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner,.'lessee, agent, architect, engineer, general contractor, electrician, plumber o~ builder. Name or owner of premises . E/VZ~'E /,f~,j ~.~, (as on the tax roll or latest dbed) APPROVED AS NOTED If applicant is a corporation, signature of duly authorized officer. .............................................. F E: (Name and title of corp')rate officer) NOTIFY BuiLDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE ~uilder's License No .......................... FOLLOWING INSPECTIONS: ,.. 1. FOUNDAT!~..,~- TWO REOUIRED Plumber s L,ccnse No ...................... FOR POUREO~NCRETE 2. ROUGH - FRAMING & PLUMBING · Electrician's License No ........................ 3, INSULATION 4. FINAL - CONSTRUCTION MUST Other Trade's License No. BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MFFT ]. Location ofland'on which proposed work will bc done. ~'~'""'"/ THE REQUIREMENTS CF THE N Y. .................... S.'r~.TE. House Number , Street Hamlet Cotlnty Tax Map No. 1000Secton // ~,oO Bock O'~. Subdivision ~./.~'.~.~.~.~ M.~/?V/,aJ C,~/vO.~SFiledMa.,No .~,.~ 'P//ac~ .. ~ ' · ' ( ahlg) ............. · ...... , ....... 2. State existing use and occupancy o£premises and intended use and occupancy of proposed c~.nstructiq,n: a. Existing Use and occupancy .75¢,",/.&0 LZ'~ ~../9/--7 ( C~. .,5/..o27~.. b. Intended use and occupancy .... ' .C-.._~../~.,~- ? ..0~.Z .~-. ~;.~ ' .; ,,? ";, ,.. 3. Nature of work (check which ~applicable): New Building .......... Addition .......... Alteration Repair .............. Removal ..... Demolition ............. Other Work . .~-"'[~.AJ. ~.~. 4. Estimated Cost ...... . . .o ~_ (Description) ..... ...................... Fee ' .---- ' (to be paid on filing this apphcahon) 5. If dwelling, number of dwellinlg units ............... Number of dwellin units o , · If garage, num bet of cars ~ g n each floor ............... 6. If business commerc .... :.',~ ' ........... .~ ............................................. , al .... ,,,.,~u occupancy, specify natme and extent of each type of use ' ' ' ' 7. Dimensions of existing structures, if any: Front ......... ' ...... Rear ..... . ......... Depth ............... ~H.eight Number of Stories ~,m~ensions of same structure with alterations or additions: Front .......... Depth I .................. Rear ....... : .......... 8 ................... 2 · · · Height ...................... Number of Stories Dimensions of entire ' · · new construction, Front ~ Rear ', ' ..................... Depth . ' ~H. eight . .' ............. Nuh~ber of Stories .... 10. Date of Purchase .~/,{..O/9,e',J /u/ ~oq~f ,,"'' :L' ........... D~epth .%~..~.~ :.~...O .......... Zone or .... m~.~..._: ','.'.' '~' "~'?' .... /'.,.t.. ~... rqame o! l~ormer Owner . ~.O. 4/.6j.Oq...~· .~. l/.,O.../.:~r~....~. 1 1 ......... -u~ m wmcn premises are situated ...... (O..(gQ ..................... .. ............... i... 12. Does proposed construction vidla~e ...... .. Will lot be re raded ^., ~ ,a,y aumng laW, orumance or regulation: /.'q..o .......................... 13. ,, .~ g ...... ,4.0~ ............. , ....... Will excess fill be removed from premises: Yes ....................... s ................... Phone No ...... . ..... ~... Name of Contractor ........ : .................. Address .......... i ........ Phon~ No ..... '.... 15. Is this property within 1300 feet of a tidal wetland~ *vo ' ...... · . ~s ........ No. ~ ..... ·If yes, Southold iTown Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly ali buildings, whether existing or prol3osed, 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 : oo'7.o0./ ~u~-r - ~-A~ ~- ~---'~ ~7~gq-..7R 'To cou vioF s. s .... L , · .... ....... J, ....... (Na~e of individual sig~i~contract). ' ' above named· being duly sworn, deposes and says that he is the applicant "eistbe dCJ . .m . ' (Contractor agent corporate officei~ '" ~ ............................ , , , etc. of said owner or owners,~and is duly huthorized to perform or have performed the said work and to make and file this application: that all statements containbd in this appl cat on are true to the best of his knowledge and belief; and that the work will be performed in the manner s6t forth in the application filed therewith. SWorn to before me this 'i ......... .day of.. . ...... ~ ' Oualifi~d In Suffolk coun~ . ...qo/-- /~.._ ~ j. - ..: .... .- ~ t~lgna~re ot applicant) Commission Expires December 8,19