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Home My WebLink About22740-zFORM NO.$ ToWN OF $OUTHOLD BUILDING DEPARTMENt' TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 22740 Z Date ..... ,m~"...~. ............................................. Permission Is hereby granted to: , /~ , z~.~...,,~..~.~~ .............. ....... CouniyTaxMap No. 1000 Seotlo~.,~,..../.¢~,..~... ..... Block .......... ~ ........... 'lot No. ~ .................... pursuant to application dated .,.~/,, .......................................... 19. ,~,, ,,~,,,,., and approved bythe Building Inspector. Rev. 6/30/80 'i~ FORMNo. 1 3 SETS OF PL,A~'tS ........ ";'~ TOWN OF SOUTHOLD SURV£Y ................. ,.~ ..... DEPARTMENT. CIIECK ...... i: TOWN HALL .. ' ' ' ...... ~xmnJned ' ' . . Approved. , ........ ,~ e itNo ...... · DJsapproved ~/c APPLICATION FOR BUILDING'pERMIt' ' .INSTRUCTIONS' a. T~s ~p~lic~tion must be completely filled in by ~pewfiter or in ink and submitted to the Build~ Inspector, with ~scts of plans, accurate plot plan to scale. Fee ~ocord~ng to schedule.. . ~ b. Plot pl~ show~8 location of lot and of fimldB~s on 2remzses, relationship to adjoining premises or pubUc or areas, and giv~g a dot,led dcscriptio~ of layout of property mu~t be drawn on thc diagram which is p~ of this c. ' The work covered by tMs application may n~t be commenced before issuance of BuUding Pe~it. d. Upon approval of this ppheatlon, the BuJldJng Inspector wQl i~sued a BuQd~g Pc~it to thc app~eant. Such pe~J sh~ be kept on the premises avaQable for ~-*~-**~- ,~ e. No building shMl be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~c. sMl] have been gr~nted ~,y ~e Building Inspector . .. APPLICATION IS HEREBY MADE to thc Build~ Dep~mc6t for the issuance of a B~Iding Pc~it pu~uant to th Building Zone Ordinance of the Town of South6Jd, .Suffolk County, New York, ~d other app~cablc Laws, Ord~ces Re~uhtions, for the construction of buQd~gs, additions or alterations, o~ for removal or demolition, as here~ desc~bed The applicant agree~ to comply with all appUcab]e hws, o~~fld~g code, hous~g code, and re~uhtions, and admit authorized ~specto~ on premises ~nd ~ build~g fo~ ,' ' ' ' '; ........ ~"--' - ...... ' ......... ~~e ~pp~nt, or name, i' a corporation) State whether applicant is owneL lessee, 'agent, architect, engineer, generM 'contractor, electdchn, ~]umber 0r builder. Name of owner of premises .................... ~ . . . ~. ~. (as on the tax roll or latest deed) Jf appJJcan~oratJon, signature of duly authorized officer.' ..... : ..... ' . . . Builder's Licens~ ............. ' ......... Plumber's Licen~ ~. ~ ~ .............. Electrician's Lice~e ~ ...... ~. . . . Other Trade's License No ..:e,s o ............. i. ~on ofland on which proposed work will be'done ~ ~ ~~/~ ~ House Number Stre~ ................... Hamlet Cou Tax Map No. ]000 Section .......... Block ..... ·. ·. Lot ......... Subdivision . . · '; ..... . .............. ; ............ Piled MapNo..... Lot (Name) .......................... 2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed conslrucfion: a, Existing use and occupan:y ~('.e ~~ ~ :~ '3. Natureofwork(checkwhic. applicabe) New Building .....,.... Addition... Repair Relmoval Demolition 4. Estimated Cost . ~ ' Alteration~v~ ' , Other W6~k'./~.-.;~ ~ (Description) ,,. ... Fee . (to be paid on filing this application) 5. Ifdwelling, numberofdwelli~gt~njts....r?./v ~ Number o{ dwelhng units ou each floor..~,,q~,,t4.~L..- If garage number of cars , ..'~/.z/~- 'i'J'il" ......... If business commercm[ or mi' ed ' , ' ,-,. , .x occupancy, specify nature and extent of:each type of use .... ~'~.f~. ........ 7. uimensions el existing structures if any: Front ..... ; ...... Rear ............... Depth .............. Height ............... N~mber of Stories . /. '~ ' ' : D~nensions of same structure iw~th alteratmns or add.tmns: Front .............. Rear ............. 8. ~menmons otentire new coni;truction: Front .... i ..... ~ Rear ...... ' ~e~tit ' ' , ="~ ............... rq~moer of Stones .................. .. 11. Zone o, ucc d~mct m wtuch premises are mtuated . 12. Does proposedq:onstruction violate any zoning law, ordinance or regulation' ...'4</..~.. , .. ~ ., r~ame oI I.zon[ractor ..... f.r~,4= ................. Address ............. . ...... Phone 15.' I.s this property within 300 feet of a tidal 'wetland? *Yes ~ ")~'~ ' ~ ........ "' If yes, Southold~Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly ~1 buildings, Whether existin~ or Proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate Whether interior or corner lot, y-ca STATE OF NEW YORK, ,'S.S ,COUN21Y OF .......... "" "" ": ........ ..... .... , . . (Name of individual sign!ng contract) ~bove named. being duly sworn, depose~ and says that he is the applicant (Signature of applicant) ' ' I (Contractor .... ! , agent, cori~orate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contained in this'application are (rue to the best of his knowledge and belief; and that the ,york will' be performed in the manner~ set forth in the application filed therewith. ;worn to before me this - Notary Public, State of N.eW York ,. ,~ .~., .o~..c; .~f?, . No. 4952246, Suffolk Counllr , 'Term Expires June 12, 19~'5 . . , .