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Home My WebLink About23426-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) 'Aa.0"�- G1// Date............... .... ................, 19..C4 . ��. 23426 Z Permission Is hereby granted to; �. ... � ................................. ... .. .............. w..k. ......../.� :...... to .... ... . ........�K.�. ....... �.... : . ....... .. .... .... .` 1 .... .... ..G .......... .... .........`.... ..... . ....................... ` .... .... .. ........ /. ... ........................................................................................................ .................................................................... ....... ................................................................................ at premises located at........... ?. ..... ... 1... �-�...T`.` ....—"' .................. County Tax Map No. 1000 Section ........ .. Block...........�......... Lot No. ......;�.'K............. pursuant to application dated ................... r.....Z ., 19..9�.�..., and approved by the Building Inspector. Fee$...�... ............. ........... .... . ........................... Building Inspect Rev. 6/30/80 FZOAD LON ♦ S od r - coAl 19. �0 3 / 00 / O f A o°Or`tL� Nr SOP NO. 49618 0 5 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . .3. . . . . . . TOWN OFSOUTHOLD SURVEY`. . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . _ . TOWN HALL SEPTIC FORM . . . . . . .. . . . . . . . SOUTHOLD, N.Y. 11971 D TEL.: 765-1B02 ttOiiFY �� / O CALL v2 .- `�. . . . . . . . Examined . .- , 19 .. MAIL T 0 : Approved . . .!!! . . . . ., 19!�. Permit No. Z � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved.a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) AP CATION FOR BUILDING PERMIT _ Date . . . /. �. . . . . . . .. 19 !y- 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 sliall ba kept on the premises available for inspection throughout the work. e. No building sliall be occupied or used in whole or in part for any purpose whatever,until a Certificate of Occupancy sliall 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. Tile applicant agrees to comply with all applicable laws, ordinances, building o e, ousing.code, and,regulations, and to admit authorized inspectors on premises and in building for necessary ii spect' a ./ �" � ?� . . . . . . . . . . . . . . - (Signature f pplicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee a e , architect, engineer, general contractor, .electrician, plumber or builder. .. . .. . . . . . . . Name of owner of premises . . ►�C-I . f�9e.�. . 0 . (as on the tax roll or latest deed) If app lit is • corporation, signature of duly authorized officer. . . . . . . . . . . . 16'1. . , . . . C� d (Nt ne and title of�orporate officer) FL9,_ r Builder's License No. APR 55 1996 1I � 1 F , Plumber's License No. . . . . . . . . . BLDG. DEPT. -- T%`IN1.00F SOUTHOLD- " Electrician's License No. . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be.done. . . . . . . .�. . . . . . . . . . . . . . . . � . . . . . . f.�. . . . �. . . . . : . . . . . . �` • . 1: . . . . . . Mouse Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . Block . . 0.!:5 . . . . . . . .. . . . Lot . -f- 1• . • • . Subdivision . . . . . . . . fit 4'`l Jh L•z.-. . .'. Filed Map No. i.05. . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2: State existing use and occupancy o premises and intended use and occupancy of proposed construction': a. Existing use and occupancy C �C . q . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . le . . . t A .1�.°r.; ?� t . U.1 VF. ;t1 . . . -3. Nature of work (check which applicable): New Building . : . . . Addition . . . . . . . . . . Alteration, . . Repair . . . . . . . . . . . . . . Removal . . . . . . � . . . . . . Demolition . . . . . . . . . . . . Other Work, L• (Description) eo 4. Estimated Cost . . . -� . : '. . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . ..77 . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling, number of dwelling units . . . . =- . . . . . .�., Number of dwelling units on each floor . ... .^- If garage, number of cars . . . . . • , • ' • • 6. If business, commercial or mixed occupancy, specify nature and extent of-each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . Rear Depth Tleig}it . . . . . . . . . . . . . . ..Number of Stories . . . . . . . . . . . . . . . . Dimensions of sanie structure with alterations or additions: Front Rear Depth . . . . . ... . . . . Height . . . . . . . . . . : Number of Stories . • • • ' ' • ' • • ' ' ' . ' 8. Dimensions of.entire new construction: Front . . . . ... . . . Rear Depth .Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . ... . . Rear. . . . . . Depth _ . . • . Name of Former*Owner IL. Zone or use district in which premises are situated . . . . . • ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation: .f... 13. Will lot be regraded NO Will excess fill be removed fro remi � ses: Yes 14. Name of Owner of premises/t f�f ?� ° !�C% . � . . . . Address/ SOu><:1 �.E'!f r� t �. done` J'o. ( J: Name of Architect .. . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . Phone No. Name of Contractor . Address . Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes• • . • . ' No. . .V(i . . ' • • *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 whether interior or corner lot. APPROVED AS MED DATE: — B.P.# FEE: �eG BY 4-) NOTIFY BUILDING DEPARTMENT AT � 765-1802-9 A11A°TO'4•-PM FOR H t �- FOLLOtti wG INSPECTIONS: Z Skis S� s Q � I. FOUNDATION - 4O REQUI ED: �. FOR P-OURED CONCRETE —? 2. ROUGH - FRAMING Z&. PLUMBI ,G; 3• INSULATION4. FINAL - CONSTRUCTION M ST BE COMPLETE FOR C.O. t ALL CONSTRUCTION SHALL M Ei'. C THE REQUIREMENTS OF THE y, STATE CONSTRUCTION- & ENE GY' f' 1+ CODES. NOT' RESPONSIBLIE DESIGN-OWCONSTRLCTIOMERR ' STATE OF NEW YR - COUNTY OF . . . . S:S . . . . . �' ' �' E . . . . . . . . . . . . . . . . . . . being dulyde sworn depos es says-that he is the applicant (Name of individual signing contract) above named. a-le is the . . . . . . . . . . . . . . . ...�;�I . . . . .. .1N e (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this-application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fortli in the application filed therewith. Sworn to before me this . . . . . . . . . . . . ..?J. . . . . ay o . . . . . . . . . .. 19 . . Notary Public, l oun ROBERT 1.SCOTT,JR. . OTARY PUBLIC,State-of • • • • - . . . . . ... . . . . . . . . . . . . . . . . . . . • . No.4725089.Suffolk Co �I (Signature of applicant) Term Expires May 31, �6