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Home My WebLink About22317-ZFORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N£ 22317 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) Date ...................... .s.~,..!,?., .............. ~,,~?,, ..... Z Permission Is hereby granted to: LOUIS & ELIZABETH FORMICA 2422 T~ESTPHALI~_ ROAD I~TTITUCK, ~ l 1952 to DE~4OLISH EXISTING OLD I~RA14E BUILDING AS APPLIED FOR. Ceunh/Tax Map No. ] 000 Section ........ !.!4 ............ Block ............. ~ ........... Lot No ....... ~1.0.,.6. .............. pursoant to application dated ................... ..A.U...G~...S..T.....2..3. .................... ] ~....,~.~ ........ and ~pproved by Building inspector. Rev, 6/30/80 ~ ,4..~ i~OARD OF HEALTH BUILDING DEPARTMENT~ ~k.,~CIIECK ............. TOWN HALL / SEPTIC FORH SOUTHOLD, N.Y. 11971 INSTRUCTIONS CALL ........ ? ..... HAlL TO: 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 pumuant 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 c~ode, housing code, and regulations, and to admit authorized hispectors on premises and in builaing for necessary inspe ,~S. , (S~t~ur~°f applicant, or name, if a corporation) · .... (Mailing address of apph~cant) State whether applicant is owner, .lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... 0~.~.e.[ .................................................................. Name of owner of premises .bI)[I,,~ .4. ~.. IL~. ~. ~.~..~I.C_~. .......................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ....................... 1. Location of land on which proposed work will be done. House Number Street Hamlet County Tax Map No 1000 Section I!t~ ~ mock 0 Subdivision .... ~..a[~/~ ............. ~r~ X ¢ '7~Filed Map~'"No ............... ~0 '~ Lot../ ...... ~.~ (~me) . 2. State existing use and occupancy of pr~ises an~ntended use and occupancy of propose~ yo~struction: a. Existing use and occupancy .... h.~ g~.~*~.. ~ .)..0~. ~:~':. ~:~. ~. :. : f:Y.; ....... .... .... 3. Nature of work (check which applicable): New Building .......... A.d,~jlion .......... Alteration .......... Repair .............. Removal .............. Demolition .., .u-... ........ . Other Work ............... ~ o ~[~ptlp-teeJ, r~_~f~ gk~J~ (Description) ~ ~ ~r~.le~. I~ ~ ~l~ oo 4. ~stimated Cost .... ~.~'. .............................. Fee ........ T.~: ......................... (to be paid on filin~ this application) ~. If dwelling, number of dwellin~ units .... ~. ...... Number of dwdlin~ units on each floor.. ~ ......... . If ~ara~e, number ofc~ ............. ~ ...................................................... 6. I~ business, commercial or mixed occupancy, spec~y nature and extent of each type of use ...~... ~ .......... 7. D~mens~ons ot exmtm~ st~cmres, if any: ~ront ..... ~.~ ....... Rear . ./~ ......... Depth . .i ............ Height .... l~. ~ ....... Number of Sto~s . . ] .................................... ~ ............... D~ensions of same st~ctur~ wi~ alt~rati~additions: Front .... ~.~ ....... Rear . ~F~ .......... Depth ..... ~ ........... HeiSt ..... ~.... ........ Number of Stories ........... ~ .......... 8. Dimensions of ent~r~w, con~ction: Front . . ~....~ .... Rear .... ~. ...... Depth . ~ ......... Height ..... p~.. J... Num~'"ber oi Sto~es . . ~ ......... , ........................ I ........... /.. 9. Size of lot: Front ...... ~ .... 5~.,. ........ Rear .... ]~(z. Deoth 3~/~ .... ~g, ~ . 10. Date of P~rchase .... ~.lJ [.~ .............. ~a~e of~o~r'6~'~n/~ ~l~ 11. Zone or use district in which premises are situated .... ~e .~ ........... 11 .............................. 12. Does proposed construction violate.~y zoning law, ordinance or regulation: ~.~ ......................... 13. Will lot be regraded ........... ~ ......... ~....oWill excess fill be removed from premises~ , Yes [ No) 14. N~e of Owner of premises ~ .e ~J~ ~.r~dress .. ~.[..~ ~ :.. Phone N~IO. N~e of Architect .... ~ ~ ~ ................. Address .. ~~,~/[7~ Phone No .............. N~e of Contractor .... ~ ................. Address ............. ~ ..... Phone No ................ 15. Is ~h~s property ~thin 300 feet of a tidal ~etland? eYes..~ .... No ......... eI~ yes, Sou~hold To~n Trustees Perm~ may be required. PLOT DIAG~ Locate cle~ly and distinctly ~1 build~, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y Shes. Give stree~d block number or d~sc~ption ac~o~d~g ~ dee&and show street n~e~ an~ ~dicate whether STATE OF NE~ /// S S -- -- COU~Y OF ~~/.~ .... ...... ~.~( ~...~.. ~(.~ ~ ~.~ ........ being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the ...~.~ ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly au~ohzed to perfo~ or have perfomed ~e said work ~d to m~e ~d file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set fort~ ~ the application filed therewith. . Sworn to befo~e this C/]~ r .... ........................... ~alffi~ In Su~k ~.~ (Si~atum of appUc~t) ~mi~n ~k~ ~m~ ~ m ~ .