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Home My WebLink About21836-ZFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEtiON OF THE WORK AUTHORIZED} 836 z ~,e ............... ,./,.~ ............................ ~9...?..~. Permission Is hereby granted to: .... ,'.~,~.ll.~.~¢. ....... ~.:......~..~.~.~./.¢.~.~ ........... ....... ./.~ ........ ~....~....~: .............. ..... ~/~..~¢...~.~........~..~.....¢.,. ....... ./.'./..~7~.~ ,o ...... ~.~..~;~ ........... ..,¢.~ ........ ~.¢..~/.......~Z<?........¢...~ ......................... ,~..~../~.....~. ....... ~..~.....~ .......... ~./..~.~ ......... ~,~ ........ ~......~.~ .... ...... .7. .~. .¢. . . ~ ....... ~ ........ ~ ~ ~ .......... ~. ~ .,. ~;¢ .................................................. .................................................................. ~.~..~~ .......................................................... at premises located at ............ ..~....~:.. ~ ....... ~-....~.,...~......, ~?~., ..'~. ........ ...~.....'~, .~'~'7; .............................. .......................................................... ~..~~.~ ....... ~....,......../../..~ ................. CounfyTax Map No. 1000 Section .....X~....~.. .......... Block ....... .~.~./. ......... Lot No ..... ~ ,.~... ............. pursuont 10 oppllcoflon doted ................ ~¢I m m m ~m ............... ~ ~l m m m m~ ..... O"d opp,oved by ~e Building Inspector, Rev. 6/30/80 FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.-: 765-1802 Examined ................. 19. Disapproved' a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH /,3 SETS OF PLA~$ ....... //SURVEY SEPTIC r 0 a,'l ........... NOT i FY; · HAlL TO: ..-'.~o~os 4o ,~ab.~' '1" ' '' "c~'" 6 ~..,~0~ ... ,.. ........~ ..~, ~-:.~: : ... Date /'L/at/. .,.~..~ 19~. INSTRU~FIO NS 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'ee or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app. cation. ¢. 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 perm 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 Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t building for necessary inspections. admit authorized inspectors on premises and in . . --' (Si°nature of a~p~li~c, an~t~o~r/name, if a corporation) (Mailing address of applicant) State whether applicant is owner., lessee,'agent, architect, engineer, generai contractor, electrician, plumber or builder Nanle of owner of premises ..... .~.../~..~. ~....ff.%.../.~..~..~.../~.~ ...................................... (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 .................... Location of land on which proposed work will be done ................................. ~. · .' ............. · ./~. ¢.~.... (~. :...~?.z.-:..--~... 2i-¢~ ........ .4V...;~./~. ~/.~ .... ~,,<-....//. ~.~..s.~ ............ llouse Number Street Hamlet County Tax Map No. 1000 Section ...:. . ././. ?.... Block ' / ' Lot .~. Subdivision ........ . ..................... ' Filed },{ap No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: · /a~-x/,o_ .~.~...c. ~e--T .... ' a. Existing use and occupancy ....................................................... .. b. Intended usc and occupancy .... ~,. .' ............................................... · 3. Nature of work (check which applicable): New Building t~..~..'~-~."qr~'(-r'~Addition ~.o.?'7-c~-~'- . Alteration ....... Repair .............. Removal Demolition ""- O~--z~ .~z~'t.4~ -oW. Other Work · ' . ~," ' '- .... (Description) 4. Estimated Cost ~.&?. ' Fee · · (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Num bet of d welling units on each floor .............. · If garage, number of cars .. ~t'v'~.. ............................................................... 6. If business, con]mere/al or mixed occupancy, specify nature and extent of each type of use ................... ?. Dimensions of existing structures, if any: Front .... ~.&..r ....... Rear . .~. ?..r. ........ Depth . ~.~..z. ........ Height .../.,~/ ......... Numbcr of Stories ·. ~..,~ -t~.. ............................................. Dimensions of shme structure with alterations or additions: Front ..... .d'?c. .... . .... Rear . .fff.~. ........... Depth . .~...°~.~j..d .~.~.'~:..~25.A~... Height ........... ' ............ Number of Stories ' ' 8. Dimensions of entire new construction: Front ../.~f ......... Rear . ~/.b. ~ .......... Depth .~..~'. f ......... Height ../~../ ......... Number of Stories . ~'~/~'. ................ , ..... ,/'~-~Y'//.~/~-~ ............ .,.. '~ Size of lot: Front ..... ' / . . ....... Depth . .~.?.~.: .............. ,. ~.~ ............. Rear ...... ./.~. '.~/... 10. Date of Purchase ....~'.~'.,e?~ .................... Name of Former Owner . Z.~.....~.~-.~.~d'.'.'.'.'.'.'.'g~.~/ ........... '~. 1 I. Zone or use district in which premises are situated .................. ; ................................ '. !2. Does proposed construction violate any zoning law, ordinance or regulation: ...'~.q .......................... 13. Will lot be regraded ...,/~.~. '. .................... Will excess fill be removed from premises: Yes (~ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor . ff//-~'. ~/~..4 .-~g~../..e~.4~.~F~.:... Address ~)X ~.'~..~.~FC(~.~¢C'7. Phone No. Z~Y..-~..a-..~.~. ... I~ this property within 300 feet of a tidal wetland? *Yes..fif .... 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 whethe interior or corner lot. STATE OF NEW YORK, S.S 20UNTY OF ................. (Name of individua~fi~rning contract) :here nan]ed. · '" ~; ..... . ' (Contractor, agent, corporate officer, etc.) ' ' >f said owner or owners, and is duly authorized to perform or have performed the said work and to make and Hie this '.pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the '/ork will be performed in the manner set forth in the application filcd therewith. worn to before me this otary Public, ' ~,:~...~. County . Nota~ Public, State of NewYork -No. 4~8225§3, Suffolk County ~'~/ ' Term Expires.December 31, 19 ~/___ . .... - ? PL~ i' PLaN FDa: ,-~.D,-D-..-,* .D -' "-" "'"'"-