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Home My WebLink About22004-zFORM NO.3 TOWN OF SOUTHOU) BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. Ne 22004 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: .......................... ./../..~.....i zl ~.<~m. :....../..~,¢;. ............................. .......... ~.z.~ ........... ~/~.. .......................... . . ,q. ~,~ ,~ .............. ~ z, ...... ~ ~ ......... z, ............ /, , .~, , , ,/. .~z , , . , , ...................................................... at premises located at ./. /,'Z~<'' ...... './..,.~..~.~,~....~.. ........ ~ ................................................. .................... ~~ ........................... CountyTax Map No. 1000 Section .....,k.~.,.~. ............ Block ...... Z~., ........... Lot No ...... ,~..'..~.. ................ pursuant to application dated ......... ..~...~/~.//*.,., ......... &~7 .............. 19.....~...~,,..: and approved bythe Building Inspector. FeeS...~.~ ...... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1803 Disapproved a/c ..................................... BOARD OF HEALTH . , 3 SETS OF PL~,~S .......... SURVEY ................... CIIECK .... CALL . . . . . HAIL TO: "-- ' ,~ffuildingInspector) APPLICATION FOB BUILDING PERMIT Date INSTRUCTIONS a. This applicati~n must be c~mp~ete~y ~~~ed in by typew~ter ~r in ink and submitted t~ the Bui~ding ~nspect~r~ 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. 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 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, and, regula_~tions, and to admi,t authorized inspectors on premises and in building for necessary in~ ...... --- .... (Mailing address of applicant) Stat,e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .k~<~ ,~d. .............................................. (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 .... .~..t~..~../?,...~..'7 .... . ..... Plumber's License No ......................... Electrician's License No. ~ t, Other Trade's License No ...................... z /w 1. Location of land on which proposed work will be done ...... ' ...........d~..~. ............ /. /. & .:. . ................... :. . /.:4 ............. . e. [.d ................... House Number Street Hamlet County Tax Map No. 1000 Section . . . .O..~77~ ......... Block ~J('~ Lot ~ 7 .~.. 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....~..~dd'..~.....~: .~....,f'~../ ..... ?..~...z~...,tpC, j.~ .~.q... 1~..~...~__~.. .... b. Intended use and occupancy .......... ~,,'~,.'.~ . ,. c - ' Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..... '.'.... Repair .............. RemoVal .............. Demolition .............. Other Work../~..z~. ~ ..... , (Description) 4. Estimated Cost ' ~ Fee , (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... i .................................................................. 6. If business, commercial or mixedl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structum~, if any: Front ............... Rear .............. Depth ............... s[9~~u e with Itc tie dditi ns F R Dimen r a ra ns ora o rent ................. ear... Depth ............... i L Height Nu bet of Stori ............. 8. Dimensigll~9~n~i~w constrfietion: Front ............... Rear ............... Depth ............... Height .~11111~.¥ .~.."?. Number of Stories 9. Size of~ ......... i .......... Rear ...................... Depth ........... 10. Date of ~~v . . i $ off .D ~ .. · .... ~ ............ amc ormer Owner ...................... ,... 11. Zoneo c e sesares uate ......................................... 12. Does proposed construction violfite any zoning law, ordinance or regulation: ......................... ~.. ..... 13. Will lot be regraded ......... [ .................. Will excess fill be removed from premises: Yes No f 14. Name o Owner of premises .... i ................ Address ................... Phone No ................ Name of Contractor . ~ ..... Address . Phone/No ...... 15. Is this property within 3!00 feet of a tidal wetland? *Yes..~.... No. ~ ...... · If yes, Southold ~own Trustees Permit may be required. : PLOT DIAGRAM Locate clearly and distinctly all ibuildings, h' ' ..... w ether ex~stmg or proposed, and. ~nd~cate all set-back dtrnans~ons from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF .' ................ .. ~~D-~.. ~ ...... being duly sworn, deposes and says that he is the applicant (Name of i~ividual signing contract) above named. ; He is the .... i. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui9 authorized to perform or have performed the said work and to make and file this application; that all statements contdined in this application are true to the best of his knowledge and belief; and that the work will be performed in th~ manner set forth in the application filed therewith· Sworn to before me this ~ ............. ~'~' ~': i .day ~f j...~-~ .~,. ...... ,19../. ~/ N°taryPu~lic'' '~' ~' '~'~'"~' '~'i: ~'-6'unty z~~~( 'g ature .,. J_O¥CEM. WI[KIN$ ' ' ...... ~ of applica~'ti ~o~arv Publle, Stere of New Yor~ No. ~t952246, Suffolk County .. Term Expires June 12, 19..~ q;