HomeMy WebLinkAbout29521-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 7FULCOMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 29521 Z Date JUNE 2/6 , 2003
Permission is hereby granted to:
ALFRED SCHRADER
575 WILLOW DRIVE j
EAST MARION,NY 11939
for :
CONSTRUCTION OF A REAR DECK ADDITION AS APPLIED FOR
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at premises located at 575 WXLLOW DR EAST MARION -
County Tax Map No. 473889 Sectioji 031 Block 0003 - Lot No_ 011 . 020
pursuant to application dated/JUNE 26, 2003 and approved by the
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Building Inspector to expire on DECEMBER 26 , 2004 .
Fee $ 150 . 00
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ORIGINAL
Rev_ 5/8/02
FIELD INSPECTION REPORT DATE COXINIENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT
TOWN HALL 26 ?r',' Do you have or need the following,before applying?
Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: (631) 765-1802 _ Planning Board approval
FAX: (631) 765-9502 ll q XSurvey
www. northfork.net/Southold/ PERMIT NO.pC ( Check
Septic Form
N.Y.S.D.E.C.
Examined G 20 ?� C tact:Trustees
Approved 20 Mail to'
Disapproved a/c
Expiration �_ 20Phone:_�
B di g I ctor
APPLICATION FOR BUILDING PERMIT
Date lO , 206-9
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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issuesla Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuan'ee or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
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 code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(S' ature o a i or n i a c rporation)
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(Mailing address`of applicant) 11 Q N
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
amu) V r, (=
Name of owner of premises-AL ae DA4 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)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
L10 A)
House Number Street let
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I- 3 -II . o ,
County Tax Map No. 1000 Section c Lot
SubdivisionA/c en'— 6 (% r ffi f&0g Filed Map No. 7(/0,90 Lot