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Home My WebLink About21657-zFO~M NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. N~ 2~657 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date....~-;.~.. ............................................. ....... ..... at premises located at.......~....~.~.. ........ .~..~~ ...... ~../2-¢,~.. ............................................ CouniyTax Map No. 1000 Section ...... .~.,, .~.. ......... Block ......... ~ ............ LotNo ......~..,..d~., ............... pursuant to application dated ...... .~././.. ........................................... 19..~... ......... and approved by the / Building Inspector. Fee $ .~, ,,,-~., ,'.~C ..... Rev. 6/30/80 F: ~' :. BOARD OF HEALTH ............ , . 3 SETS OF PLANS ............ ~ml~3 fi SURVEY ..................... CBECK ...................... SEPTIC FORM ................ BLDG, DE)'~r. TOWN OF $OUTHOLr~ FORM NO. 1 TOWN OF SOUTHOLD BUILDI-NG DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL,: 765-1802 NOTIFY CALL ?~.~. J .0Q.O .~ ~ ......... MAIL TO: Examined ........... , 19 ./c~. Disapp rov e c~i11[~4£11 ~$ NOT. ED ......................... ....... :~_~ .... · .... -~ ~-.,. .......... ~... 76B-~802 9 AM m 4 PM FOR THE (Buil~ng Insp~}j ..... ~ 'r mtLOWm~; ~US~CT~O~S: ~. mUN~AT~O~ - ~OamU,~emP~LmAT~O~ ~Oa BU~LmU~ FOR POU~ED CONC"ETE ~ 4. FINAL CONSTrUCTiON MUST INSTRUCTIONS B~! C~PLET[; FOR C.O, ~L~l~(~p~[~'~u~so~M~ly ill]ed in by ~pewfiter or in ink and submitted to the Building Inspector, wit~ 3 s,ts ~[~aq~-~~ p~ t~aM,~.Fee according to schedule. ,b~.t g~fl~y{~'~¢Mc~.ioB~Ot and 0f buildMgs on premises, relationship to adjoining premises or public streets or ar~o.s~i~ gi~ a~~ri~h of layout of property must be drawn on the diagram which is pa~ of tMs appl- e. The work covered bY t~s application may not be commenced before issuance of Budding Permit. d. Upon approval of this appJication, the Building Inspector w~l issued a Building Pe~it to the app~c~t. Such pc~it shall be ~ept on the premises avaQable for inspection thtou~ou~ the e. No build~g shall be occupied or used Jn whole or in part for agy purpose w~atcve~ until a Ce~ficate of Occup~cy shall ~ave bee~ gra~ted by the BuJld~g Inspector. APPLICATION IS HEREBY MADE to thc ~uild~g Dep~ment for the issuance of · B~lding Pe~it pursuant to t~e 9gilding Zone Ordinance of the Town of Southold, Suffol~ County, New York, ~d other applicable Laws, Ord~ces or Regulations, for t~e const~cfion of buQd~gs, additions or alterations, o~ for ~emoval or demolition, as hete~ described. The applicant agrees to comply with all applicable laws, ordinences, bnQd~g code, housin~ code, and regulations, and to admit a~t~odzed ~specto~ on premises and ~ buJld~g lot neccssa~ J~spectio~. (Signature ~l~cant, or name, ~' ~'~ (Ma~lin~ address of applic~t) State whether applicant is owner, lessee, agent, ~chitect, engineer, geheral contractor, electrician, plmnber or builder. N~me o[ owner oFpremises ........... , ...... ~.~ (as on the tax ~olJ or ]a~est deed) J[ applican~ is a corporation, signature o¢du]y authorized (Name and title of corporate officer) Builder's License No... ~.~ ~a~%...~ 2... ~71 .'~ .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l. Location of land on which proposed work will pc done. ' .... ' ............................... ' .x¢. · ...................... I. ~ .~.. ~.~ ~. ~ .... House Number Street, Hamlet County Vax Map No. lO00Section ..... 2.~.'-- .... ...' Block .... q ...... Lot O.0 Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a ~xistmg use and occupancy . ~..~.~ · ~;~ ............... ¢~r.., ~r,., ?,-?,2; ,,~,-~-~w~r~ b. Intended .. ~,... ,~. ,~, .~Om...~ 3. Nature ofwor~ (check which applicab e)' New Bu id n" ' · ~ ' ~ ......... /mmtmn ....... ... Alteration ........ Repair ............. Remo? .............. Demolition ............. Other Work..~.~... ~-~.~. I (Desc ption) 4. Estimate'dCost ., i~ O~,.~..~ ................ Fee ..... t.~O..O ................... ' (t g thi ppi/ ) $ led ; o be paid on illin s a cation Iii q N ' · welling, uumbero£dwe ng nits ............... umberofdwelling units on each floor ....... If garage, number of cars .... i ......... · ...... 6 i[fb ·. ........................................................ 7' usmess, eommermal or mixe occupancy, specify nature and extent of each ty~e of use ............. · Dimensions o existing structure ,if any: Front.., ............ Rear ............... Depth .............. Height Number of Stories Dimensigl;~ ............ ' .................................................. of same structure wi~h alterations or additions: Front Rear - i ii ' Depth ' Il[eight ...................... · · · · 8 .................... ~ ...................... Number of Stories ..................... · Dimensions of entire new construction: Front Rear Height Number of Stories ............................. Depth ............. 9 Size of lot: Front ................................................. · · .......... ~ .......... Rear 10. Date of Purchase .(; .................. Depth ............... .......... . ............... marne of Former Owner .................... 11. Zone or use district in which premises are situated ....... 12. Does proposed Construction violate any zoning law, ordinance or regulation .... b-). ~ ...................... 13. WilIlot bere~raded . . i ' . .... 14 Name of c~,,,~,o~ ~e-.~.~ .... "~ ...... 5'f ' ' ', ......wd~ ex~ce,~.s ~I_be r~mov,ed from ~remises: Yes Nt ~,~ame of ' .: i .... ess ........... x= ..... ~o~ne No ....... Architect ........ ~. ~ ~ ........ add~ol4 ~ ~.%~r~ ~.<:m ~ ~ .... .. ' ~ ., ~-~,~ w~-~.-.~-n.~uu ~eet or a t:tdal wetland.* ~¥BS.,..;NO.~... ~I:~ yes, Southold TownI Trustees Permit may be required. ~ PLOT DIAGRAM I Locate clearly and distinctly all !bui/dings, whether existing or proposed, and. indicate all set-back dimensions frotr property lines. Give street and block ~umber or.description according to deed, and show street names and indicate whethe: interior or corner lot. j STATE OF NEkt~'~q~Rk,.('~ I] ~ I above named. lie's t m /~ ' ' ~ , ' ............................... or --':, , ()~.. ~. ~COntractor~gent, corporate officer, etc.) ........... · =~,a pwner or owners a~ ~s 0ul~ mt mr~form or have e ' apphcatmn; that all statem~ts contained i~ n,~ .... ~ .... p rformed the smd work and to m~e and file this Work w~ ~. ...... '- .... a :_ .;:..:~ ....~,,,.$~c:?"i~ ,2?-*at~on are ~rue to the best of his knoxvledge and belief' an vO~ tO Delore me this , ,~ . , being duly sworn, deposes and says that he is the applicant (Signature of applicant)