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Home My WebLink About22616-ZFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) Date ............ ..~./~., ..................................... 22616 Z Permission Is hereby granted to: .~.'.~,~ ....... ~.....~...~.,~.~ ~ , . ~._:_..: ~~.~...~m......~?~- ~ ,o...~.c~ ............ ~.'..'..'.~4~......~ ........ ~......~~ ...~ ....... ~~ ........ ~ ........ ~~. .......... ~ .......... ~~ ...... ....... ~~~ .......... ~ ....... ~ ........ ~(....~ ......... ~.....~ ........... ....... .......................................................... ~~~ ............................. ~ ................................ ~, ~,~,~,~ ~, ....... ~ ........... ~......~~ ................................................. ......................................................... ~~ .................................................................... oo~,~o. ~000 ~o,io,....~ ......... ~ ....... ~ ......... ~o~No..~ ................ pursuan~ to application dat~ ...................... ~/~ ....................... 1 9_,.,~,, and approv~ by ~e Building Insp~tor. ~ ~.Z~.;~ ...... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD ~UILDING DEPARTMFNT: TO~'N HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .... .'-ff./~. ....... 19.?.0/ Disapproved a/c ..................................... BOARD 0F HEALTH ........ 3 SETS OF PLANS ........ SURVEY ................. CIIECK .................. SEPTIC FORH ............ CALL .................. HAIL TO: InslSector) Date../~. ~{~. :/~ 1974. BLDG. DEP'[ !.._ ~TOWN OF SOUTHpLD ' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 sti-eet 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 permi 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 Occupanc: shall have been granted bY the Buildir.g Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, orff~or removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, b¢if~ing code/~housing code, and regulations, and tc admit authorized inspectors on premises and in building for ~{ctions, & . . . ........................ -- '~ (~ignature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generi~l contractor, electrician, plumber or builder. N~me of.owner of premises .~..~.?'v.q~.. ~..~..~.A~.~Z2. O4e~.. ~...5.~..-?-~Aqt~..-q..AY..c-J~/..... .............. 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 ...................... (as on the tax roll or latest de~[lll0~D ~$ [10lI[} DAT ~O~ BUI~ING DEPARTME~! AT 765-1~2 9 ~ TO 4 PM ~E FO~OWING INSPE~ONS: 1. FOUNDATION - ~O REQUIRED FOR ~RED ~R~ 2. R~H - ~MING & ~UMBING INSUliN 4. FINAL - CONSTRU~ION MUST SE COMPLETE FOR C.O.* ALL CONSTRUCTION 8HALL MEET THE REQUIREMENTS'OF THE N.Y. I. Location of land on which proposed work will be done. STATE CONSTRUCTION & ENERGY ~ .. ': ............... ~-~'d~!~.' '~ior' 'RE~SPONSm'LE' ' ~OR .... .... ¢. ........ ........... ' ........... .... ltouse Number Street Hamlet Cou'nty Tax Map No. 1000Section ...~i'.~.. ........... Block.......'~ ....... ..' .... Lot .c>~...ff.... Subdivision.. ~ ................................. '. Filed Map No ............... Lot ............... (Name) 2: State existing use and occupancy of premises and intended use and occupq~;,,,X.O, rop'osed ~:o~stl, uction f4~.. ~. a. Existing use and occupancy ........ ~ .............. _~ --' ...... ,4 ............... b. Intended use and occupancy ......... . ............ · ......................... ...................... '3. Nature of work (check which applicable): New Building ·.. Addition .......... Alteration .......... ~-'~-~:----'~ ~ Other Work...-... Repair .............. Removal .............. ~.. ................. ·~,~, - .... (Description) 4. Estimated Cost . ..~ %'~'~ . ............ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... . Number of dwelling units on each floor ................ · If garage, number of cars .................................................................... .... 6. If business, commercial or mixed occupancy, specify ~ature and extent of.each type of use ..................... 7. Dimensions ol existi~n~ structures if any: Front ~£[£-4~..[b ..... Rear ............... Depth .2~.~-~?~...~..tT.. Height .,8[./.~q.x¥; ./,~.' .... Number of Stories ..... .¢~. ,~ .......... .... ................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ....................... Height ........... ' ........ ,.. Number of Stories ...................... 8. Dimensions of entire new construction: Front .............. ; Rear ............... Depth ............... Height Number of Stories 9. Size of lot: Front ......... ~ ......... k.. Rear ....................... Depth ...................... I0. Date of Purchase .................... ' ......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ................................................ ' ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will 10t be regraded ...... ~'. ...................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises' ~- ~.'~T~ ........ ~ [~ .<¢¢>~.. ~,..~r~ss ......... .......... Ph on e I~,,.:t '.' ' ' ,"~'~ ..... ;"'' Name of Architect ........................... Address ................... Phone N~6 ................ Name of Contractor .......................... Address ............. ...... Phone No ................ 15. Is th:[.s property w±th±n 300 feet of a t£dal wetland? *Yes ........ No ......... · If yes, 5outhold Town Trustees Perm±C may be requ±red. 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. STAVE OF NE~"~OP~ /,~ S S COUN'rY OF ' .... ~.~.. ~ ~...~..,, .: ....... · ......... duly sworn, depose.s ~d says that he is the applicant (Name of indMdual signing contract) ~bove named, {els the . .. ................................ ' ............................................. (Contra r'porate officer, etc.) ' >f said owner or owners, ~d is duly authorized to perf~ or have perfumed the said work and to m~e ~d file this pplication; that all statements contained ~ this'application are true to the best of his ~owledge and belief; and that the york will' be perfumed in the m~ner set forth ~ the application filed therewith. ;worn to before me t~s ............ ~ '' 'C '"' .day of~ ..... aAmt t. · ............... ~A~BLIC,~te~ ~ ~ ' (Signature ofapplic~t) ~ahf~ in Suffolk ~ ~]/~ '