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Home My WebLink About23222-ZFORM NO.3 TO~l~l OF $OUTNOLD BUILDING DEPARTMENT TOWN ~ SOUTHOL~, N.Y. N? 23222 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Permission is hereby granted to: ~;- ~'~ ~- .~?~.,c.,~'~ ' .. ~ ~..... ~,~,~-~...... ~ .............. ..~ ........ ~ ......... r~:~.¢ ........ ~.~ ......... ~.~ ......... ~ ......... ~<~..~, at premises located at ................... Counly Tax Map No. 1000 Seotion.......-r~.j'~ ........... Block ........ ~..~- .......... LotNo....~,,Z ....... II /~] 1 9....~.~ and ~.,~.an, to o~,oat,on ~a,ed .................. ~.~.. ....... ....................... .... a~rov~ b~ Building Insp~tor. F~ $...~. ~ ........ Rev, 6/30/80 t/OP~ NO. I TOI~N OF SOUTHOLD BUILDING DEPARTHENT TO~/N UALL SOUTHOLD, N.Y. ]1971 TEL... 765- 1802 BOARD OF HEALTH ............... 3 SETS OF PLANS , ......... i .... SURIrgY ,..,~, ..... ~... ......... SRPTIC FORH ................... APPLICATION FOR BUILDING PERHIT INSTRUCTIONS a. This applicatio~ mist be cu~letely filled in by t~p~iter or in ink and unl~itted to the Buildin8 Inspector vlth 3 sets of pl~ns, accurate plot plun to scale. Fee acco~dir~ to sdk~hle. b. Plot plun sh~i~ lecatio~ of lot and of buildi~s o~ praises, relatio~/~ip to adjoinin8 praises or p~blic streets or arees, und givi~ e detail~l descriptio~ of la~,~t of v~op~r~y ~ust be th~n o~ the diasr~ ~,t~ich is part of this ai~licatiom c. The ~ co~ed by this application ~ay ~ot be coaae~ced befoce isec~ of Buildir~ Pemit. d. Upon ~,~al of this ~pplicatlo~, the lhildi~ Inspector viii isune ~ lhildi~ Pemlt to the applicant. pamlt shall be kept un the O~,,~ises available for insl~ctio~ throt~hunt the e. No buildi~ shall be eccupi~d or used in ~.~ole or in pm-t for any purpose ~hate~er until a Certificate Occh~T shall ha~ berm Brunted by th~ Buildi~ Inspector. APPLICATI~ IS ~ Ha~ to the Euilding Del~h=,t for th~ iss~ee of a Buildi~8 Pemit porsemt to the Buildiu8 Zo~ O~din~ of the To~ of ~outhold~ ~folk C~ty, Ne~ York, und other applicable Luns, O~inauces-.or P~ulations~ for the constmctlon of buildi~s, additioas or alteratlees, or for ~tal or a~lltio~ as herein described, lhe applic~t aS~s to ~,ly vith all applicable l~s, ordin~s, beildir~ co~, beusi~ code, and ~ulatioas, and to ~l~it unthorized inspectors ee p,u~ises and in b~l~ir~ f~or necessary ins~ctio~. I~'q/nature o[ appl~r_~t, or ~a~, ~r a corporat~onl (l~hilh~ *ddcess of at~licant) State ~hether applicant is ~er, lessee, a/~mt, architect, e~ineer, Eer~al co~trector~ electrici~m, pl~b~r or builder. Na~e of o~er of premses .................................................. (as on the tax roll or latest deed) If applic~t is a ~,,~atio~, siEnature o~ duly authorized officer. (l~m z~d title of corporate officer) Ph~bers License No. Electrieiuns Lict~ No ...................... Other Tra~'s License No ..................... Locatio~ o£ l~d on ~ich ~o~-d ~ viii be doee .... ~ ............ , ............................................ ............. ......... ............................................ House ~r ~ r~ ~. ~ ~d~ .... ~.~ ...... ~ ........ ~ ...... ~t .... ~.., ~i~i~i~ ...................................... til~ ~ ~ ................ ~t ............... ~. ~st~ ~ ~ ~ .... ~~ .~...~~ _.. ~ ~g~ ........... b. ~t~ ...... ........... . .............................. /~ ~ 3. l~tere o[ ~ork (check ~hid~ applic_able)~ ~ l~ilding .......... /~ldition .......... Alteration .......... Repair ........... . )~,wal ............. l~olition ...~,<~..... Other ~ork ..... ................ 4. Estimated Cont .~.. · .C?..~.~. ........ f~ ..................... (to be paid on filing this application) 5. If d~lling~ r~ber of duelling units ............ l~mber of daelling units on each floor ................ If garage, ~ber of cars ...................................... 6. If bt~sinass, omm~reial or nd~ed ~eetq~ey, specify nature and extent of ea~A~ type of use ...................... 7. Dimensions of existing etruetures, if any: Front ................ Rear ............... l~epth IleJght ......................... l~t~ber of Stories ...................... Dirmnaic~s of same structure ~ith alterati~o~s or addition.s: Front ............... Rear ............... Depth .................... Reight .................... Nt~ber of Stories ............... 8. Bimenaiccm of entire ne~ c~mstructiun: Front ................ Rear ............... Depth .............. Height ......................... l~her of Stories ..................... 9. Size of lot: Front ...... , ............. Rear .................... Depth ..................... lO. Date of Purchase ..................... ~ of For~er O~ner ......................................... I I. Z~e or use district in Mai~ premises are situated ; ............................................................. 12. Does proposed constrontion violate any zoning la~, ordinasee or regulation: ........................ 13. I~ill lot be regr~od ? ....... . ........... Will ~sa fill be removed from prmdses; }4. ~S of ~r Of pL'emiseS ............ Address .............. Phone ~ .......... ~ of Architect ..... ; .............. ? ............... Address .............................. Phone ~ ............... lx~ne of C~traetor ,. ................................. fiddrese ............................... Hmna No ............... 15. .Is this property ~ithio 300 feet of a tidal ~etlaed? * ~.~ .......... lib .......... PLOT BTAGRAH Locate clearly and distinctly ail buildings, ~hether existing or pro~sed, and iedicate ail set-hack dimensions from proparty lines. Give street and block nmtmr or description according to deed, and sh~ street ~s and indicate deether interior or corner lot. (~~t~ra~ offi~r, etc.