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Home My WebLink About19337-z FO~,~ NO. ~, TOWN OF SOfT, OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Date ...... ?~.~ ................................. , 19..~.?. Permission is hereby granted to.:/~ / .....~/~~.~..~.....:~ ................... .... ..~/,.~..,...~....~... ...... ./...~.~ ........................ ....... ...... ......... .,. ..... County Tex Map No. 1000 Section ..... .:~..~.,...,~.,.. Block, .............. ./,.,.. Lot No....~ ........... ~././..~. , pursuont to opplication doted ........................................... , lC)..~...~., and approved by the Building Inspector, Fee $.....,~ ~ Rev. 6/30180 ~provcd ..... · ~'~'".... ,, I · Permit No.. 3~' sapproved a/o ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS FORM NO. '1 SURVEY TOWN OF SOUTHOLD ,,...C,H.EiCK ............ TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY: TEL.: 765-1802 CALL ....... MAIL : INSTRUCTIONS Date. a. This application must be completely filled in by typewriter orin ink and submitted to the Building lhspector, with 3 t of plans, accurate plot plan tO*scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,~r~lationship to adjoining premises or publle streets areas,, and giving a detailed, description of l~ynut of property must be drawn on the diagram which is part of this appli- ¢, The work covered by thig application may not be commenced before issuance of Building Permit. . d. Upon approval of this application, the Buildin- Inspector will issued a-.Building Permit. to the applicant. Such permit ,,c: ?o. bu.lding.sha!l be occupied or used in whole 6~n part for apy~p"$s~X~hat'gv6'~'n~t'~a"'~e~ificate of Occupancy ,~ nav~ neen granted ny the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ding Zone Ordinance of the Town of S0uthold. Suffolk County, New York, and other applicable Laws, Ordinances or elations, for the construction of buildings, additions or alterations, or for femoral or demolition, as herein described. applicant agrees to comply with all applicable laws, ordinances, building code, housing code. and regulations, and to it authorized inspecto~ on premises and in building for necessary inspections. (S~onature ct apphcant, or name, ifa corporanon) (},{ailing address of applicant) ; whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. c o£ owne ~ ..... P.u.d.g.e .C.o.r.p r o~pl'em roes ............. · ............................................... a', *"~ ',, (as on the tax roll or latest deed) ilicant is a corpgration; signature of duly authorizcd officer. tuildcr's Lideris~ No qumber'$ LicenSe No ......................... ilcctrician's License No. ~.) cation ofland on which proposed work tvill be done; Cox Lane Industrial Park Unit # I ~' ' ' 22355 qqu. n.t~. ?.o.a.d .4.8 ~ h U~. · ..,..,.,...,... .... ...,. . ... ...... .., utc ogue, N b St ....................................... use um er reel '' Hamlet mty Tax Map No 1000 Section 8.z~ ' ' Block .1 26 ; , ................ ' .................. Lot ...............-...,. ~d~vl$1on ..................................... Eiled Map No ............... Lot ............... (Name) · ;c ~.~i~lin~ u~ and occupancy of pr~mi~s and Inlended us~ and Occupancy of proposed ,confinmion: ~. Existing use and occupancy ........ I. Intended use a~d occupancy ............................... Nature'ofwork (check which applicabIc): New Building .......... Addition .......... AJtcration ........... Repai.r .............. P,~moval . .i ............ Demolition ........... Swimm£ng pool ............ Tennl. s Court .... ~/.,~.~ Accesllsory Buildin§ .......... Fe~c'e.,~.%.. ..... O~:her t'/ork ............ E Cx.J , : (lo bo paid on filing this application) Ifd~el, lng number of dwelling units ' Number of dwelling units on each floor If garage, num bet of cars .......... i ......................................... . ........... [£business. commercialormixedoccu~ancy, spccirynatt, reandextentofeachtypoofuse. . . ' ' ...... D,mensmns of oxtshng structures, ff aqy: Front ......... . ...... Rear ........ ; ...... Depth ..... Hei_eht ............... Number of Stories ...................................................... Dimensions of same st~gt~g, rr~ with alterations or additions: Front ................. Rear ...... ' Dimensions of entire new cons~mctmn. Front .............. Rear ............... Depth .... Hci-~ht Number oflStodes · ' Date of Purchase ' Name of Former O~vner Zone or use district in which premises bre situated Does proposed construction violate any zoning Jaw ordinance or regulation: .............................. Will lot be regraded ' Will excess fill be removed from premises: Yes No Name Of Owner of premises . ~'pltg~. ~9.rp: .... ".... Address .]}qx..1.4.6.5. .S.o.u.t.hp.:L.d.. Phone No.. 10 ':L8 9 ..... Name of Architect ! Address Phone No Name of Contractor .... 13:coy. ~:9pOl~.r.u.c.t~9.n ..... Address .B. qs, .1. t.4.5...S.o.u.t.hp~,d. Phone No.. 7~,7,t{~9 ...... Is this property lot&ted within 300 feet of a tidal wetland? *YES .... HO..X. ,~][£ yes, Southold Town TrUstees Permit may be ~required. ,. i PLOT DIAGRAM oOeate clearly and distlnctly.all buildings, whether existing or proposed, and. indicate all set-back dimensions from erty lines. Give street and block n-mb~r or description accord.Lng to deed, and show street names and indicate whether' ior or comer lot. : (Name of individual signing contract) thc i - ~ (Contractor, agent, corporat2 officer, crc.) d owner or owners, ~d is duly auth~odzed to pc[form or have performed the said work and {o m~e and file this :atica; [hat all statements contained i~ this application are truc to tim best of his kno~vlcdgc and ball,f ;and that thc will be perforated in the m~ner set fgrth in the application qlcd therewith. ~ Public, St W No. 4879505 Qualified in Suffolk Coupty ~ml~lon E~lres De0embe[ 8, 19~