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Home My WebLink About22056-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. N-o 22056 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ................ ........................... Permission Is hereby granted to; ~ ....~,..~: .......... ~.y..... ......... ./.../.~.~: .... ,o......~..~.~.~ ......... ~ ....... ~~ .......... ~ ......... ~ ........ ~ ............ ..~ ......... ~.....~ ......................................................................................................................... .~ ,~ Building Inspector Rev. 6/30/80 N, 33 'Z2 SO ~ h"I A t r',l LANE," ~acilities f, or this loc~tion have been . ~f FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ¢7/,2_ ~,?//L~- TEL.: 765-1802 ^ppro,ed .......... l Permit No. Disapproved a/c ..................................... . (~,dild~g h p ) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS .......... SURVEY ................... ClIEc[ .................... SEPTIC FORH CALL ............ MAIL TO: : Date .................. , 19... 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 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 applichtion 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 app//cant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, i~' a corporation) ~.9.'~..~..z~ F, ?~o .I~Y (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .~. w..~ .~.,~. ' ' ~ . ........ Nameofownerofpremises ~.~.,~- eeO . Y~rm e~ D L/ C ................................................ A~V~ AS'NOTE~ ....... (as on the tax roll or latest ~ ~o~ Ir applicant isa corporation, signature of duly authorized officer. .............................................. 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) FOLLOWING INSPEC~ONS: 1. FOUNDATION . ~O ~EQUlRED Builder's License No .......................... FOR ~URED C~CR~E 2. ROUGH - FRAMING & PLUMffiNG Plumber's License No ......................... ~. INSU~TION 4. FINAL - CONSTRUCTION MUST Electrician's License No ....................... SE,COMPLETE FOR C.C. ALL CONSTRUCTION SHALL~MEET Other Trade's License No ...................... THE REQUIREMENTS OF THE N.Y. STATE CONSTflUCTgO$ & ENERGY CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done .................... O~IGN'OW CONgTR0CT~O~ ~gbg~' . .~ .......... ~?.~5 ~...U.~ L..~.& ............. ~,./¢3.~.~ .~.q .n ..... ~r[~ .( ............... House Number Street Hamlet County Tax Map No. 1000 Section .... ~ Block ~ Lot ~ ~. Subdivjsio6'. .................................... Filed ~ap No. . ~.~ I ...... ~o~ ............... (Name) State existin~ use and occupancy ol Premises and intended use and occupancy of proPosed construction: a. Existing use and occupancy .................................... b, Intended use and occupancy .......................................... 3. Nature of work (check which hpplicable): New Building .......... Addition .......... Alteration .... '~... Repair .............. Removal .............. Demolition ............. Other Work... /~.~ .D. q! (Description) dC 4. Estimate est ................................ Fee ................................ (to be paid on filing this application) 7 5. If dwelling, number of dwelling, units ............... Numb r of dwelling units on each floor .... .~. · If garage, number of cars ... / ....... ~ .......... commercial or mixed occupancY, ................................ 6. If business, . specify nature and extent of each type of use ..................... 7. Dimensions of existing structuie~ ;r o,y: ~ Rear Height ................................. : D. ~p.t.h. ............... Nu~nber of Stories ' Dimensions of same structure With alterations or additions: Front ' Rear Depth I Height ................................... 8 ........................................... Number of Stories ...................... · Dimensions of entire new consimction: Front Rear ' Height Number of Stories .............................. Depth ............... 9 Size oflot:'Front I0' Date of Purchase .......... ! ............ Rear ...................... Depth ......... ' Name of Former Owner I I. Zone or use district ~n whm remmes are situated ........................ ......... ......... i~l g 1 ............. 12. Does proposed construction v ate any zonin aw, ordinance or regulation: ................... 13. Will lot be regraded ...... ~. · ........ ..................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises i ..... Address .............. Phone No .... Name of Architect ......... i ................. Address . Phone No ............ Name of Contractor ........ i ................. Address ................... Phone No ......... . ....... 1300 15. Is this property within . feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold ~own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and Noel number or description according to deed, and show street names and indicate whether interior or comer tot. STATE OF'NEW Y. ORKf~ff')~ ']P ' cousry sis ............ ~ t {- ~ ~ ~ ..~. ?. i.q.~. ?.. being duly sworn, deposes and says that he is the applicant (Name of individual signin) contract) ' above named. · ·. H is the ' 53.,z/,~ ~r~ : i ontractor, agent, corporate officer, etc.) of s.aid owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this apphcation; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Sworn to be. fore me this .......... otaryPu li4.. ..aWy.. ... ...... ounty Notary Publlo, State of NewYo~k No. 4879505 Qualified in Suffolk County /.///"it/ " ppli~t) . . Commission Expires December.8., 19.~.