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Home My WebLink About21563-zFORM NO,3 TOWN OF $OUTHOLD BUILDING DEPARTMENT '[oWN HALL $OUIHOLD, N.Y. No- ;)1563 Z BUILDING PERMIT (THIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / Date .....~./.~.. ..................... : ...................... 19.?~...... ?- Permission is hereby granted to: o ..................... ~.~ ....... ~ ....... ~/~.,~.~...~.~,~./.'.,...,~.~........z~..~ s,ooatedat...~..~..~..~ ....... '~/~-,~.~.....~.~/.......7.....~',~. ................................. County Tax Map No, 1000 Section ......... ~....~.. ........ Block ......... ~ .......... Lot No..//f...'~. .............. pursuant to application dated ......./~.. ...................................... Building Inspector. ~... 19..,~,~. ...... and approved bythe Rev. 6/30/80 · ·' FOaMNO. r~'~ ~..,~,..=~~--~I' TOWN OF SOUTHOLD JUL I 3 993 TOWN HALL ~l~l SOUTHOLD, N.Y. 11971 ~.U~T~- ~ TEL.: 765-1802 · Disapproved a/c ...................................... '. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ....... 3 SETS OF PL.x~{S ........ /SURVF.¥ ................. /ClIE~K .................. S~PTIC ~ 0 ~,'1 ............ ~HAIL TO: . a. Tiffs application must be completely filled in by typewriter or in ink and submitted to thc Building Inspector, with: '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'eet 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 tiffs 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 sha/l 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 Certificat~ of Occupan¢) 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 c..qde, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti~. __~ · / / ' . . --' (Signature of applicant, or name, if a corporation) .... N.c./.... ,.%...'4..3/.. ,'/. v..g.,f... (Mailing address of applicant) State whether applicant is owner, lessee,'agent, architect, engineer, general contractor, electrician, plumber or builder. · Name of o~vncr of premises ...~. ~.~.~544).. 5:..~../?..O.,q.....['4..~.~./. ......................................... (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 ................... House Number Street Hamlet County Tax Map No 1000 Section ...~...~. ..... · ...... Block ~ ' Lot . ..//.- ''~ Subdivision . . ~.~ (-- .,4~.r~ /J Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. lntended use and occupancy ..................... ' .................. . , ... . property lines. Give street and blockinumber or description according to deed, and show interior or corner lot. 4. Estimated Cost ..... ,. . f dwell,ng, hum ' ' (to be paid on filing this application) 5. I ber of dwelli g units ....... ' Nurflber of dwelling units on each floor..c. ..... If gar'~ge, number of cars ........ 7' '~' . . . - .- ....uupancy, specny nature and extent of.each type of use · ~amensmns ol existing structures if any: Front i .................. Height N"mb Depth ' .' ........ · .:..Rear ............. ~ er oz ~tories ' ........ Dimensions of shine structure. With alterations or additions: Front ............ Depth ' ' i Height ' Rear · Number of Stories ' ' ' 8. ~mens~ons of entree new cons!tructihn: Front .............. :' Rear .'.'v. ....... Depth ............ .Height ............... Number of Stories ...' ...... .... ; ........................... 11. Zone or use d,stnct In which premises are situated ~5~in,~ rmer Owner .~..d,~.~'.~: .... .~.~,~44 ~ ....... .12. Does proposed construction vlola~te~y zoning law, ordinance or re-ulatio-.' ' ' ' ' .............. 13. Will lot be regraded ........ ] .................... ~/ill excess fill be removed from pr~mises: Yes Name of Architect .... '7. .... 1 .................. Address .... ~ .............. Phone No. ~. . Name of Contractor ...--: .... i ............. Address "- · · · · ' . Phone No..-7... ' 15.' I.~ this property within ~300 feet of a tidal wetland? *Yes'.'.'.'~.'.'.'.'.' No ......... · If yes, Southold iTown Trustees Permit may be required.. ... [ ' PLOT DIAGRAM Locate clearly and distinctly ali buildings, y~heih~r existing or proposed, and, indicate all set-back dimensions from street names and indicate whether APP. ROVE:¢,aS 76~4g02 9 AM ~ 4 P~FOR THE FOLLOW~NG ~[~SPECTiONS: .1. FOUNDATff)N , 'B~O REQU}RED FO~ POU~ED CONC~ET~ 2, ROUGH - FN~M{NG 8~ PLUMBING 3. tNSULATIO~ 4. FINAL {~O~St'RLICTION MUST BE COMPLETE FO~ C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUC]~ON ERRORS STATE OF NEW YORK, COUNTY OF .......... S.? g./..w..O,q 1.,e_, ' (Name of individual ~gmng contract) above named. being duly sworn, deposes and says that he is the app leant te is the 0 ~ Xf~'.J~. ' ' (Contractor agent corporate officer ) ........................ ,f said owner or owners and is duly ~uthorized to perform or have performed the said work and to'make and file this pplication; that all statements contained in this'app ication are true to the best of his knowledge and belief; and that the /ork will be performed in the manner set forth in the application filed therewith. worn to before me this - . _._....J