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Home My WebLink About23380-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...... .. . . ........ ....... . ................. 19.*..... W 23380 Z Permission Is hereby grantertZ, ................ I-ev.......P.. ............... ......�D, .. .. ... .5.1/.................................. .............................. to .... . -...... ...... .. .. ..: .......... ....... . .. . .......... i ........ ....... .... .............. . .... .. ..........................`�........49.1.0... :..... ......................................I................. ..i..7............................................ . .. ........... ............................. atpremises located at............&."5.'69. ...... . ................f,......./L.................................................... ....................... .........................................� k .........Imo.......................... ............ County Tax Map No. 1000 Section ......./. .. Block..........:a........... Lot No. .. ............ pursuant to application dated ....... .............. 19..�74e. ...... and approved by the Building I`nnsspector. Fee $...1 . m....... �� .. .. ............................... .... Building Insp or Rev. 6/30/80 HOARD of BEALT11 FORM NO. 1 3 SETS of PLANS TOWN of SOUTHOL,D SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . APR i TOWN HALL. SEPTIC FORM . s SOUTHOLD, N.Y. 11971 pEpT. i TEL.: 765-1802 NOTIFY: F BLOF SOU?HOLD ..� ,_q 3 OWH CALL, l F.xanined. ... 1 MAIL. TO: . . . . . . . . . . . . . . . . . . . . A 1. 19.... Permit No. 1 .✓...5/. .................................... Disapprova/c .................................... ( ilding Inspector) APPL. CATION FOR BUDA)ING PERMIT Date. . . . . . . . . . . . . . . . . 19. . . . INSTRUCTIONS a. 'Ibis application Must be-caiipletely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate"V pt plain to .scale. Fee according to schedule. b. Plot plan showi rig,location gflot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving,a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be cownenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throujiout 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 11LItEiIY 1fADE_to_t}ne iuilding 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 tbe-construction of buildings, additions or alterations, or for removal or demolition, as herein described. .Tiie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to aclait authorized inspectors on premises and in building for cessa inspections ................................ (Signature o- applicant, or ne, i a corporation) XN( .. .. ..... (Il<3i1.ing acklress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .Z-4-�J' .....�. ................................................... Naveof owner of premise .. ...... . .. . ................................. (as on line tax roll. or latest deed) If applicant is a corporation, signature of duly autlxorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ......................... Plnni)ers License No. ......................... ElectriciansLicense No. ..................... Other Trade's License No. .................... I. Loca((t��ionnnof land on wliidn proposed rk w' .1 Ire do�. , .................��!........A .. ................ ................................................. llajse Nunlner StrYL D nlet County 7�3x Map No. 10()0 Section .. ....... i�l.ock 3 .._........ innt ..�� .......... Subdivision ...................................... File(] Map No. ......._...... Lot (N�-me) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................................. b. Intended use and occupancy ............................................................................. :). F!-nture of conk (dveck %kith aplAicable): NLni Ikrilding .......... Acklition .... Alteration ........ Ilepa i r ............ ItcmiovaI ............. Deiix)l i t ion ............ Other I�cerk �'... ................ qC', (Description) 4. Lstinrated Cost ..��.'.X.�........... fee .............................................. (to lie paid on filing this application) 5. 1 f ckx-I I ing, rxiiirer of dwell inn uni is .........._. Umber of owel 1 1ng tuei is on each floor ................ If garage, insibLr of ears ...................................... G. If lxrsiness, ccnneercial or mixed occupancy, specify nature aril extent of each type of use...................... 7. iliurensions of existing structures, if any: IN-o nl:................ Rear .. ............. Depth ................. Ileiglel' ......................... Umber of Stories. ...................... Dimensions of sane strtrcLure with alterations or a(kliLions: Front ............... hear ............... i epth .................... Ik:ihlrt .................... Umber of Stories .. ............. 0. Dkensious of: entire Frew constrtx.Ciou: Front hear .... ........... Depth .............. lieig;lnl' ......................... Ntnher of Swries ..................... 9. Size of lot: Drone Rear .................... Dept Ii .................... IO. Doce of Purchase Nrxrle of Former Ovmer ....... ................................ . 11. Z.cxw or use district in Wleidn premises are situated .............................................................. 12. ik)es proposed coosl:nxaion violate any zoning law, ordinance or reguladon: ........................ B. Will lot he regraded .................... Will excess fill Ire removed from premises: YES NO Ill. Hales of (Mwr of premises ........................... Acklress ...._......................... PI►ane No. ............ N;rnle of Architect .................................... Acklress ... ........................... Phone No. ........... Mine of Ce)etractor ................................... Acklress .......... .............Mone No. ........... 15. is this property within 300 feet: of a tidal weLlarxl? * YES .......... NO Y '�!..... *iF YES, -kXlllrXD 'IUM 'Ill MU-1S P-K-INI ' HAY iIE 10 VIM, PLOT' DTAGRAH Icx:ace clearly aril distincl:ly all lxril(lings, tAeether exist:ing or prolrosed, anll irxlicate all set-back dimensions frrne prolrercy lines. Give street aril block Fruber or description according to deed, arxl slow street .naves and irxlici to tAeether interior or corner lot. AU OV D AS NOTED, r DATE: C NOTIFY BUIL 1NG D 755-1802 S AM TO 4 FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED �) <<a FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4 TION M BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL M THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR rRO�p r. ......... ..!��`.. �!V.1 `!..:.!............beirr'. duly Y sworn, delxnses <uxl says that he is the applicant (mviie of irxlividual. signing; contract) above niggled, /� Ik! is l.lee ...........0 u6. je.V...................................................................... ((kmt.ractor, regent, corlxwaLe officer, etc.) of said owner or owlx:rs, awl is duly authorized Lo Ix>rfonn or have (ierfonrred the said work aexl Lo tmike aril file this rgrpl icaCion; Lhat all. statements contained in this appl;tcation are t:nx to the best of Iris knowledge aril Ixal.ieN alxl that: (lee work will. be lrerfonned in the nwinner set forth in Lhe application filed Urerewit-Ir. :worn Lo before ne Olin I ............1. :':`day:,of V .l.. 199 ... Notary Publt y�+x e (Signature of Apill icnnt.)' �L.CLEW ; l!�otai Pilb)io,'State.of f!P®mvYork Qualified1h Suffolk County Commission Expires December 8,19� ov f f Qd 1 1 I - -