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Home My WebLink About22019-zFORM NO.3 TOWN OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 22019 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) at promises Iocatea at.......~...z~...~.,..U~.. ......... ~,.....?....~..'. ................................................................ .......................................................... ~~.....~..... .................................................. CountyTax Map No, 1000 Section .......~..~ ..........Block ...... ./....~....~';., ......... Lot No ....... ,..~..../~... ............. pursuantto app,,oa,,on dated ...... ~ ....... ../..~ ................... 19....,q..~...... ond approved byt~e Building Inspector. / ~" Building Inspector Rev. 6/30/80 .cam No. 3 SETS TOWN OF SOUTHOLD SURVEY i /~ii I 2~ BUILDING DEPARTMENT CIIECK ......... ~ ........... TOWN HALL sEr'rlc rO~,~! .............. SOUTHOLD, N.Y. 11971 TEL.: 765-1803 NOT,F? ] ¢¢ .... .... .... .... Approved .............. , 19~Pe~it No..~ ~.~'~ ~ ' Disapproved a/c . (Bffildi~g Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 sti'eets 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 igsued 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 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, housjag code, and regulations, and to admit authorized inspectors on premises and in building for neces~ml~y-i-~pecti~ ( ( ,/ -' I\ . ...... -- . (Signatur9 of applicant, or na~e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pre ]ses ...................................... ..wx\ ....... .~. ........................ . (as on the tax roll or latest deed)'l~PPll0~ED ~$ applicant is a corporation, signature of duly authorized officer. DATE: ~8.R #~ If .............................................. NOTIFY ~UILDING DEPARTMENT AT (Name and title of corporate officer) 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: Builder's License No .......................... 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE Plumber's License No ......................... 2. R~)UGH o FRAMING& PLUMBING Electrician's License No ....................... 4 FINAL CONSTRUCTION MUST .~E COM. t..ETE FOR C O Other Trade's License No ...................... ALL eOF. STat CTiON SHALL MEET T¢!F REOUIREM~NTS OF THE N/Y, 1. ,';; ,qT'~ CONSTRUCTION & ENERGY Location of land on which proposed work wilkbe'done ...................... , ...................... Itouse Number Street Hamlet County Tax Map No. 1000 Section ... ~.~.~-~.. ...... Block ...~,.. .... ' Lot. :.*'/ ............... Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupanCar-~f proposed construction: a. Existin~ use and occupancy.. ~2CI.~.~54-.~L.L~.. ~.~-~....~.:~..{..~.. ...... .~.¥.C~...C~., ?.. ................ .. b. Intended use and occupancy ................................. , ........ ~,. ................... '3. Nature of work (check whlc]~ applicable): New Building .: ........ A.'d~ition .......... :. r~t. mn-.-.-. ...... Repair .............. Removal .............. Demolition ..... Other Work..'T~.. ~..~..~.~.. ,. ·" .... q Ocsc/i ti; i 4. Estimated Cost ... . ' ...... j ' ' (to be paid'~~tlon) 5. nuwemng, number of dwelling units -, ~ -- '.~~" - . · .............. ~umoer oI Owelhng units on 6ff~'. .......... If garage number of cars J ' ~i~[ ~efy' '~ed occupancy, specify nat ........ ~ '; .......... 6. c ml or m: ........ · · · 7. uj!~nd extent of.each type o u mwn~lun~ oi emsnngstmctFres if any Front ~*~ : Rear ~ ~ ~ .................... .............. · ....... Depth ............. Height ............... NFmber of Stories ...~ .......... D' ' of' tmctu e' ithalte fion additi F ........ ~ .......... ~ .... ~ R ........ lme~SlO~S same s r w ra s or OhS: ront · · ~ ......... e r.. Depth .. ' · · ~i,h, ' · ....... 8 Dimensions of enti '~ ...... ~ ....................... Number of Stories...~ ..... '. 2 . · re new con'stmction: Front ..... ' R ....... Hight Nflmbe f St .......... ear ............... Depth ...... e ............... r o o~es ..... , ............. ' ....... 9. Size oflot: Front ... '[O~ ....... Rear ...10~ ........ ~. De~th 10. Date ofmurchase ~'~' .(~:~ ........ me ofFomerOwner . .... '. Na ~M~ "~ ................ 1 I. Zone or use district in which ..................... prem:ses are situated ................. · 12. Does proposed construction v olate any zoning law, ordinance or regulation: ........................... 13. Will lot be regraded ~. .. ,,, ' ' ~ 'i .... ~, ~ ......... WUl excess HII De removed from premises: Yes No 14. Nme of Owner of premises .~lg~l~Eq~ ~ q~ ~ ~ Nme ....... Address . hone No of Architect I ....... ............................ Address ................... Phone No ................. Nme of Contractor ....... :. · · . Address ' .. Phone No ........... I~ this property withih 300 feet of a tidal wetland9 i<Yes ........ No...~. ' .... ~:f yes,'Southold Town Trustees Permit may be required. ... ~ PLOT DIAG~ Locate clearly ~d distinctly ~1 buildhgs, Whether existing or proposed, md. indicate fll set-back d~ensions from property Hnes. Give street and bio k number or description accord~g to deed, and show street nines and indicate whether htefior or corner lot. (Namo of individual sign~ng contract) above named. S.S ~.L.~.. ~ .Q.'.. ........ being duly sworn, depose? and says that he is the applicant J (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements cont-~ined in this'application are true to the best of his ~owledge and belief; and that the work will be perfomed in the manner set forth in the application filed therewith. ' Sworn to before me t~is ......... ~.~ ..... uay . _ ,· ............ :::..: ~o. _ . . ~ .. ~ . . . · (Signatu~ofapplic~t) 144,~ T f2 84-~105 TITLE NO ............................ g.c. TAX HAP ~ LOT ~J,~ .J 0 66® 07' 40" E tO0, O0 $. C,T&X M&P LOT T S 66° Ol' N.Y.S. RTE. 2 5 MAIN I00.00 NORTH ROAD ROAD SUFFOLK COUNTY TAX MAP DAVIO L, GILL, FS PIE,4R' BLOCK ...................... SECTION ................... ~AP oF__ PROPERTY ~.OCATION .... 2.2..I. ~N._OR..'F..H. _R.~.~,.D~ (3R£E:NPORT, N,Y, DISTRICT SEcTiON BLOCK LOT ,00 5 2 T l). CRA, CHi, JR..l). E. & L.S. CONSULTING ENGINEER SCALE 1";:40FT. DATE dUNE ,[TOWN OF $OuTHOLDI N. Y, STATE LIC, NO, 27052