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Home My WebLink About23357-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 FULL COMPLETION OF THE WORK AUTHORIZED) Date................. ......... ......l...................... 19 . Nf 23357 Z Permission is hereby granted to, �',,.../.. ..�f........ .......... .... �� .......................... to ..... ....... ... ... ...... . .. .... .. '-... .....-........ . ............::�-c ............... .. ......................................................:........................................................................................................... .................................................................................................................................................................. �� atpremises located at.................................�.... .......................................... .................................... County Tax Map No. 1000 Section ........... . Block.............. ........ Lot No. ....6 6�................. pursuant to application dated ................. ................ 19....I... ., and approved by the Building Inspector. m Fee$. ............ ....... ....................)x.. .......... ..... Building Inspecto Rev. 6/30/80 _....--- ♦ . . . . . �� (5 FORM NO. 1 1i0�1k' U OF HEALTH /3 SETS OF PLA,rs . . . . . . . . TOWN OF SOUTt10LD /-SURVEY . . . . . - - - . . . . . . . . . k BUILDING DEPARTMENT /CIIECK . . . . . . _ _ APR 2 — 1996 TOWN HALL SEPTIC F0Rrt . . . .. . . . . . . . _ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NOT I FY i CALL .7��ec'la Exantincd-. . . . �. . . . . ., 19 / HA I L TO : Approved . . / . . ., 194-e�"Perrnit No. . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . _ . . . . . . . . . . . (Building lnsp tor) PLICATION FOR BUILDING PERMIT y/ Date . . .`/. . . . . . . . . . 13 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 plats to scale. Fee according to scliedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this., 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 permit shall be kept ors 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 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 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 inspectoo (Signature of applicant, or name, /iff a� corporation) (Mailing address of applicant) T State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Qt�cJ!V&/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . Name of owner of premises.. •'.•. . . . . �Dod P. .v.'. �. . . .. . ... . . . . . . . . . ... . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant, is a corporation, signature of duly aguthorized officer. t (Nance and title of corporate officer) Builder's License No. . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . .. Electrician's License No. Other Trade's License No, . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . k. . . . . . . . . . . . . . . ... . . . . . . . . /Ll�.v T� .. . .. . . . . ? :u �.-! . . . . . . blouse Number Street I-lamlet County Tax Alap No. 1000 Section lock . . . . . . . . : . . . Lot . . . . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . (Name) '. State existinb use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . ... . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended 1� iu �St�-C—. . . . . . . . . . . . . . . {?t.;lrgLr'➢': .6 Ti12,J, use and occupancy :�.&t•t •at3t:!2•.�3i,+t;l!`r YqA� 7i+>t -3. Nature of wort: (check which applicable): New Building Repair . . . . . . . . . . . . . . Removal ' ' ' ' ' ' • • • • Addition . . . . . . . . . . Alteration . . . . . . . • • • • • . . . Demolition Other Work lv 4. Estimated Cost . . . . ® �: � (Description) . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. If dwelling, number of dwelling units . . . . (to be paid on filing this application) � ' If garage, number of cars . . . . . . . • • • •. Number of dwelling units oil each floor , . . . . , , 6. If business, commercial or mixed occupancy. s spec . ' ' . . . ' • ' ' ' ' ' ' ' ' ' ' ' ' ' • ' 'I y nature and extent of•eacli type of use • . . • 7. Dimensions of existing structures, if any: Front . ' ' ' ' ' ' ' ' ' ' • height . . . . . . . . . . . Rear . . . . . . . . . . . . Depth . . . . Number of Stories . . . . . Dimensions of same s'tructure with alterations or additions: Front Depth . IIeig}�t . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . 8, Dimensions of entire new construe . . . ' . • . ' ' ' ' . • • Number of Stories . . . . ' ' ' loon: Front Rear • � • ' • • ' ' ' 'I-leiglit Nl�mber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . .lopf q 0 Rear . . . , , . . . . . . . 10. Date of Purchase S J�-_. . . . ... . . /'r� ..C� (. . : . . . . . . . . DepthV a !� :c� . . . 0.... .1w; 'fir . 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. Syill lot be regraded /lV . • . . . . . . . . . . . . . . . . . . . . . . 14. Name of Owner of premises T",6;e�,.g Will excess fill be removed from premises: Yes NU- Name of Architect Address :_f!!d",� z � wt�pjlone No. Address . .'�3L/-llv�:_.'.1 ` Name of Contractor " " . . . . . . . . . . . . • • • Phone No. Address . Phone No. L5, Is this property within 300 Feet of a 'tidal �wetland? *yes. "*If yes,' Souphold Town Trustees Permit maybe required, No K . , , , 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 or corner lot. ::_.... AP ® AS wQTED DATE: B.P.# C;Z 33J�% �\ NOTIFY 13UILDING 0 765-1802 9 AM TO R ! FOLLOWING INSPECTIONS: OR THE (C'uu -c 1, FOUNDATION 69� FOR POURED CONCRETE EQIJIRE® ' 2• ROUGH . FRAMING & PLUM13ING 3- INS0-4-1ION r 4. FINAL - CONSTRUCTION-MUST 1� BE COMPLETE FOR QO. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION &- ENERGY 3 CODES. NOT RESPONSIBLE FOR j. DESIGN OR CONSTRUCTION ERRORS TAT)✓OF NEW �M' OUNTY 01 . . S.S being duly sworn d'ePoses •of individual signing contract) and says that lie is the applicant )ove named. . is the . .•. . 491 5w'pora-te officer, etc.) said owner or owners, ,and is duly authorized to perform or ha plication; th ve performed the said work grid to make and at all statements contained in this application are true to the best of his knowledge and belief; and t ilat this )rl: will be performed in the manner sd forth in tl,ie application filed therewith. turn to before me this . . . . . .. . . . day..o�. �/ . . . . . . . . Mary Public, . . . . . Ala\`` ` )(— OBERT1. . County N ARY PUBLIC.State of IN.Y - No.4725089.'Suffolk Cou • • • • . . . . . . . - Term Expires May 31, IS!' . . . . . . . . . . . . . . . . . . . . . (Sipn9fnrr of•,nnlir"int)