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Home My WebLink About22950-ZFO~M NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN ~ $OUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN'IlL FULL COMPLETION OF THE WORK AUTHORIZED) Date .......................................... ~ //~ 22950 Z ~ Permission is hereby granted to: ~ ~., ~..Z....s..~ ............................. __. ...~....~~-~...../.~....z/.~.~ opplic~on dated ............... .,~.... ~.~..,19.. pursuant to Building Insp~t~, Fee $.../~ ............ ................... ~,., .................... ~ ......... Rev. 6/30/80 ~BuJldlng 1995 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT: TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 sETs OF PLA~S ......... SURVEY CIIE£K ........ ~ ......... SEPTIC ;OF, H ....... Approved .(~...~/5. 7..., 19~. ~erm' it No. 8.~...?...~ '~ Disapproved a/c ..................................... (Building,"~''insp~ A'~ BUI]'LDING PERM'I; NOT ! FY ~ CALL ~ .................. HAIL TO: Date ........ , 19,.. INSTRUCTIONS a. Tiffs 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 sti'eets 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. Tlie work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued 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 South01d, 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, bujl[ling code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~p.p~tions. 9q.~ /~ . · .. ........... i 20. /~OX ~ ~ t '(Si~/itire of applicant, or name, ifa corporation) ....................... ~"/T]~/a'4// /~ [/ //~'3 ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No .......................... Phnnber's License No ......................... Electric'an s License No ....................... Name of owner of prenilses .......................................................................... (as on tile tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~PPR0V.[[~,~ [~0T[D~_ _ / 76~-1S02 9 AM TO'",,4~l~r~l THE FOLLOWING INSPECTIONS: 1: FOUNDATION· - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4: FINAL - CONSTRUCTION MUST Other Trade's License No ...................... SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET i. Location of land on wliich proposed work will be done ...................... T. HE .REQUIREMENTS. OF..'THE .N.¥. STATE CONSTRUCTION & ENERGY ................................................. ' ................ C. 00~$....NO.T...8g$ .PONlSlIII, I~. lfouse Number Street H~tGN OR CONSTRUCTION ERROR8 County TaxMapNo. 1000Section ... 'J.~..~ ........ Block ...~.. ' Lot..?. .............. Subdivision ' Filed Map No ............... Lot ...... : ........ (Name) , State existing use and occupancy of premises and intended use and occupancy of proposed constructioni a. Existing use and occupancy .... ~.~. ~./>/..~.~..../-./~..Jif..~. , ........................... b. Intended use and occupancy ..................... ............................................... 3. Nature of work (check which applicable): New Building ......... ; j..~dition .......... Alteration .... : ..... Repair .............. Removal .............. Demolition ,,<...: ......... Other Work ............... 4. Estimated Fee ............................. A j//72 (to be paid on filing this application) 5. If dwelling, number o f dwelling units ........... Number of dwelling units on each floor ................ . If garage, number of cars ....... t~//~.t~ ............................................ j~/~ ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .../f//~. .............. 7. Dimensions of existing structures, if any: Front ...3D.t ....... Rear 20" Depth /.0 ' Heigllt . .~O..~ .......... 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. Sizeoflot: Front ...................... Rear ............. ; ........ Depth ...................... 10. Date of Purctlase ............................. 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 lot be regraded ....... ; .................... Will excess fill be removed from premises: Yes No 14. Name of Owner ofpre~nises .................... Address ................... Phone No ................ Name of Architect ........................... Address ......... . ....~ ... .... Phone No ................ Nmne of Contractor .......................... Address .............. :.... Phone No ................ Is this property within 300 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. 15. / lO' STATE OF NEW YORK. S.S COUNTY OF .................. .... ~.~.~.4~.~t/~....f~....../~,~/~.~/../ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract} tbove named. ......................................... ............ (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this ~pplication; that all statements contained ~ this application are true tO the best of his knowledge and belief; and that the york w~l be perfo~ed in the m~ner set forth in the application filed the[ewith. ;worn to before me this ......... ..... 4ota~mublic, ...~~F~~ounty ~ ~ . ~ ~ · ~ M. ~s ~ ~ ~ - ~ · ........... Ne. ~9522~, ~ ~ · ~ (Signature of applic~t)