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HomeMy WebLinkAbout26431-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26431 Z Date APRIL 41 2000 Permission is hereby granted to: i GREGORY LECRANN/ PO BOX 82 EAST MARION,NY 11939 , for DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. � Ev 1K90 at premises located at 4200 ROCKY POINT RD EAST MARION County Tax Map No. 473 89 Section 021 Block 0003 Lot No. 032 pursuant to applica on dated APRIL 3, 2000 and approved by the Building Inspecto . Fee $ 5 . 00 Aut�ze ignature COPY /2/19/98 FORM NO. 1 I? TOWN OF SOUTHOLD l BUILDING DEPARTMENT 2 TOWN HALL SOUTHOLD, N.Y. 11971 BLDG, DEPT. // TEL.: 765-1802 TOWN OF SOUTH LD Examined IANW-. 19Received . . . . . . . . . . . , 19 . . . Approved U(Jk4a . .1�? 195t?Permit No. 14. 1 • •� r Q Disapproved a/c CLA"4L.I PY. . ►?t-?{o-k��aT�c�9t D jUN 1 61986 ' (Building Inspector) _, BLDG SOUTHOLD TO�yN OF APPLICATION FOR BUILDING PERMIT Date . . /Z. . . . . . . . . . ., 19R. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 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 streets 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 this 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 shall 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 Certificate of Occupancy 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 code, housing cod , and re ulations, and to admit authorized inspectors on premises and in building for necessary inspections. Sig e�of lic ( ant or name, if a corporation). . . . . . . . . .x:?. . . . . . . . . . . . . . . . . . . . . . . . . (mailin .address,of,ap i.cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . .G.'L\f. ^d . . . . .41. . . x !/ lX. 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. .f f.1:C:. . .��^�� • . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . .11� . . . . . . . . . . . . . r�� -: . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . . . Block . . . . . .—3 . . . . . . . . . . Lot .- . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' f a. Existing use and occupancy . . . . . . . . . Q4 �=n�-�-�y w,ee b. Intended use and occupancy : , . . . . . . . . . . . . . . . . . . . •gib° �y' ti 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteratio i Repair . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . of ,/ pQ l (Description) 4. Estimated Cost . . . . 1W.10. . . . .� L�!i°. . . . . . . . . . . . Fee . -�K. '. . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . .:. . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy,specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 74' -Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . fight . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of e**9 new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Ulei . . . . . . . . . . . . . . . .Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . :. . . . . . . . . . . . . . . . . . . . . . Name of Former Owner 11. Zone or use district in whh premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . 15. Is this property located within 1.00 feet of a tidal wetland? * Yes . . . . . No . . . . . * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing 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. STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . • • • • • • • • • • being duly sworn,deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application d therewith. Sworn to before me this . . . . . . . . . . . . . .C�. . . . . . . .day of. . . . . . . . . . . . . ., 19 P.l� Notary Public, . . 1 � - . . . . �.?- . ... . . . . Countyj�,, NNk 7 7ftA*3of applicant), � ■MEEN RIVERS MEN i �. SEE M m No SEMMES EN RSIMON ' t,p ■NR NIMMEIMMIMN.�i EMOSIMMEMEMEME 7NONE OEM SS�.II■■�, M�N.g■. ,�� ��EMIME • Ei �. •� EME� Nii.iii�.■■�.■ �aq■L.gar■=i''iiG rr■r_ "��- .'SII ■ ■ 7■ I . 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