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Home My WebLink About27545-Z{ -FORlt NO. ! TOl/lq OF soIn'HOLU BUILDING DEPARTMENT TOWN SOUTHOLD, N.Y. I 197 I TEL: 76.5-1802 !~.-~,,,{ t,.~d ................. · 19 .... ~,~ ................. , ~9 .... ~,~ m. ~:/k."/~..~ Di~r.~,,~l ale .................................. BOARD OF BEALTH ............... 3 SETS OF PLANS ......... ' ...... SURVEY ........................ CHECK ......................... SEPTIC FORi4 ................... NOTIM: CALL .................. lt~lL TO: .................... (Building lmu2ector) APPLICATION FOR BUILDING PEP, HIT INSTRUCTIONS a. This applieatim m-~t be e~apletely, filled in by typewriter or in it/t and sul~tted to the Building Inspector ~ 3 sets bf plana~ ~rate plot pl~ to scale. Fee __~rd_ ing to sebedfle. b. Hot plm shmfing loeatlon of lot and of buildings ~ g .... :ses, relatiooship to adjoining pranises or public streets or a~-eas, and giving a detailed description of la. ut of prope~tl ramt be dra~ on the dingran vhieh is part of this .pplieation. e. The ~o,k covered by this applieatio~ ,~.~y not be e~,~-~d before iss-~ee of Ihilding Pemit. d. Upon ~oeal of this ~liea£ion, the Building ~,~eetor will issue a lhilding Pemit to the ~pplieant. Such pemit shall be.kept m ~ prendses ~ilable for inspection ~hmugbout the work. e. No building l/roll be occupied or used in s/role or in part for any purpose v~hatever ~mtil a Certificate of Oe~?,~-y ei~11 have been granted by the bailding Inspector. ata~ICATIa~ IS [s~am~t ~ to the Building Dep~;.,~,t for t~e issum~e of a Building Permit pursuant to the Building Zone Ordinance of the To~ of Southold, Suffolk County, Ne~ York, and oeer applicable Ls~s, Ordinm~es'or Regulations, for the comtmctio~ of build/n?~ ~dditions or alterations, or for refusal or a~molition, as herein resulations, and ~o ~t authorized inspectors on praises and in building for necessary~ ~spectic~s. (Sigm~re of a~p'lieamt, or n~e, if a corporation), lllectrici~ Li~n~ lb ...................... Other Tr~'s Lic~qe l~ ...................../':~ .~.~/F./,~'~..~..~.. !. toeation of lm~.t on ~dch propm~ ~ ~,dll !~ done .... ,././.~../,....,../ ............................... Bouse ~her Street County Tax l~p No. 1000 ff~etion ...... ~..g/. ...... Block ...~./~. ......... Lot ....~/. .......... sa~,io~ ,.~/f.r.~.s~/- ~ Fn,~ mp ~o...Sk.~.~ Lot .... 31 ........ 2. State ~sti~ use and oc~ .ma~y of pi"~,,lses and intuited use and oc!~mnc~ of p~-oposed construction: a. ,tlng ........ ... ,~' ~ ~ ;~_~i~b~ ~,~ ........ b. ~ ~ ~ ~ .............................................. ~,~;t ....... ---~:-~-.~. ~ ~ 15. I~ture'of ~ork (check ~hid~ applicable): ~ Building .......... Addiriun .......... Alteration'. ......... ~" Repair ............ l~.<~ral ............. Demolitioo ............ Other klork ..... D f..~...~....~...~i~. ~....Z~.. .(Description) r,, ted bt ..... ........... .............................................. (to be l~id on filing this. ~plication) If d~elling, n~ber of d~elling units ............ l~ber of d~elling units on e~ch floor ................ If garage, nmber of cars ...................................... If business, a~.~.~rci~l or mi~d occupancy, specify nature and extent of each type of use ...................... Dinensiona of ex/sting structures, if any: Frunt ................ Rear ............... 1]eprh ................. Height ......................... limber of Stories ...................... Dimensions of s~.~ structure with altaratiuns or additions: Frunt ............... Rear ............... Depth .................... Deighr .................... l/~ber of Stories ............... Dimensions of entire ne~ coostruction: Front ................ Rear ............... Depth .............. Height ......................... l~her of Stories ..................... Size of lot: F~t .................... Rear .................... DeprJ~ ............... . ..... l~are of P~rdmse ..................... I~,~: of Former O~ner ........................................ Zune or use district in ~hid~ premises are situated .............................................................. Does proposed constructioo violate any z~ming la~, ordinance or regulatiun: ........................ ~ill lot be regra,l~ci .................... I~ill o~,ess fill be ~ from premises: YES l~s of O~er of pr~{ses ........................... ikIdress .............................. ~ No .... , ......... ~ of Architect .................................... Address .............................., ~ 1~o ............... ~ of Co~trsctor ................................... /~dress ............................... ~ No .............. Is this property within 300 feet of a tidal ~etland? a ~S .......... 1~0 .......... PLOT DIAGRAH I~ate clearly and distinctly all buildings, d~ether existing or proposed, and indicate all set-b~k d/~nsions f,~, v, overty lines. Gi~e street and block r,~her or description according ~o d- .~cd, and sh~ street ,~n~s and indicate ~hether interior or corner lot. oo .................................................... being duly sworn, deposes and says that he is the spplicant )L,,~ of individnal signing cuntract) ie is the ................................................ . ............................... (Cuntrsctor, agent, corporate officer, ere.) ~f said (~er or owners, ~mnd is duly ~tJlorized to perform or have perfoLum~;~ ~le said work mid to m~ke ~nd file this ,pplicatio.; that sll st~tu,.~.ts cunta/ned in this am,lication are true to the best of his knowledge ~nd beliefl s~d .Imf the work ~ill be perfonm*d iu tim m~mer set forth in the ~pplication filed therewith. MAP SHO WING UNITS ..29__,30.31 & 32 PI-IEASANT RI. IN ESTA TES A T GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40.01- 01 - 28,30.31 & Sca/e; ?'" = 30t $OUTHOLD, N.Y, 119XI NO. 49618