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Home My WebLink About22966-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. ...�... N2 22966 Z Permission Is hereby granted to; �y rV to .... . ....... .. .f..... �. ... � ...... ... .�4—........ ....... . ��, .... ....... �. .:...................... ...... . .. ... .. � . .... .............. ............. .. ...! . .. ................................................................................................. .....................................................................................................�...,... ................................................... at premises located at........... !� .... .....:.!'..c.................................................... ....................... ......................... ............e-7m.y.:..................... ............ County Tax Map No. 1000 Section ......... ...... Block.......f................ Lot No. e.7.................. pursuant to application dated ......................` .�...�.............. 19..�Z f/ and approved by the Building Inspector. Fee$.... `l.... Building Inspec r Rev. 6/30/80 lri .".;V'..°;.•.9�:�,` '. :;s�,rl ;}'; BOARD OF HEALTH . . . . . . . . . FORM NO. 1 J SETS OF PLANS„ ,.,,. x ,.�_:' .•j`' SURVEY . . . . . ... . . TOWN OF SOUTHOLD • • • • . • • . . BUILDING DEPARTMENT CIIECI: . . . . . . _ _ _ . . . . • , , . TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NoTI FY CALL Examined . . 19( t•IA I L TO : Approved . . 1 19 . . . Permit No � . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . (Building Inspec or) P ICATION FOR BUILDING PERMIT Date .C� . . . . 1 0� 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 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 Occupancy 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer;'general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . P .�4� 6-AS No . . . . . Name of owner of premises . . ./. , . . . . �, —.,5' �; DATE' R.I'# (as on the tax roll or latest dqq_.'IFY BUILI iNG If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TOqP N AT F®LLOE't,'ING.INSPECTIONS . R THE : . . . . . . . . . . . . . . . . . I. FOUNDATION - T1J;/i) 'REQ' UIRED (Name and title of corporate officer) FOR POURED CONCRETE 2. ROUGI-i . FRAMING & PLOM—PING Builder's License No. . . . ,�, � �� 8• INSULATION 4. FINAL - C► NSTRUCTION MUST Plumber's License No. . . . . . . . . . BE COMPLET8 FOR C.O. - ALL CONSTRUCTION SHALL MEET Electrician's License No. THE REO UIREMENTS STAVE OF THE N Y . COf'�STRI.lCT101V � ENERGY _ Other Trade's License No. . . . . . . . . CODES. NOT RESPONSIBLE DESIGN OR CONSTRU FOR . MS . . 1. Location of land on which proposed work will be done. .l�.:4-'.>�,.�, G �. . . . . . . . . . M r .`r. . . . . . . . . .... . .pocl. ... . . . . .. I-louse Number ` Street Hamlet County Tax Map No. 1000 Section — �")' / Iilock . . . Subdivision . . . . . . . . . . Filed Map No. . . .. . . . . . . . . . . Lot (Name) . 21 State existing use and occupancy of premises and 'intended use and occupancy of proposed construction: a. Existing use and occupancy l,•4�c � � . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy e ./. ��'��i��G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •3. Nature of work (check which applicable): New Building . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . .: . . . . . . . Removal . . . . . , , . . . . . . . Demolition , , , , , , , Other Work . if< (Description) 4. Estimated Cost : . . .� . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. 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 a ent of each ty e o .0 7. Dimensions of existing structures, if any: Front . . , . Rear Depth Height . . . . . . . . . . . . . . . Number of Stories t Dimensions of same structure with alterations or additions: Front Rear Depth . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . 'RearDepth. . .Height . . . . . . . . . . . . . . . Number of Stories . . .. . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . ... . . Rear. . . . . . . . . . . . . . ... . . . ... . . . .. 10. Date of Purchase Depth . . . . . . . . . . . . . . . ... ... . . . . . . . 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. Will lot be regraded Will excess fill be removed from remises: Yes No 14. Name of Owner of premise s/l1 �r .r��Address . 55 1.7.•.(/1!pi , Phone No.�.X& X1�7 , 1 mow- Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . Phone No. .�, / Naive of Contractor . Address .Phone No. 15. Is this property within 300 feet of a tidal 'wetland?� *YeS.. . 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 narnes'and indicate whether interior or corner lot. �r � 'Pa a p � -- CX Ole 1 TATE OF NEW Y R Q � OUNTY OF . . . . SS MQY.gveX,vk. . . . . . . . \. . . N'' • • • • • •.• • . : . . . . . being duly sworn, deposes and says that he is the applicant ( ame of individual signing contract) ; )ove named. SV.:p e is the . . . . • (Coil trac r, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this {plication; 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 filed therewith. vorn to before me this Lo'. yojStia Dtary Public, . . . CountyROBERT 1.NOTARY PUBLN.Y.No.4725089. up�tY (Signature of applicant) Term Expires May 31.19 � �- � � � � � so FT ��n�� ,� � � � � o N � J �► � � � G . s � . , -� � � ��