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Home My WebLink About22976-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) 9 i Date.............�..�.9............................... 19... NP 22976 Z Permission Is hereby grante to; 1.G/�2/5............:..........&..��-/. �/ AE L/ / .................... .................................................................. -� . ........... to ..��51z-. 11. ...... ............'..;." ......... .........1 ..,., 2........��' i,................ s .......��i=............ ... .. ;...........��.................. ..........�..—.............. .. .... ............................................ .................................................................................................................................................................. .................................................................................................................................................................. ............................................................:G >zK .......................................................................... at premises located at............ll ..........I 4'/!?..� .. ........................................................... ....................... ................................ n .............................. ...................., ............ G� �ram.- CountyTax Map No. 1000 Section .... ✓ 1............. Block.... .........,.. Lot No. ......... .................. pursuant to application dated .........'61 rJ.-.{ 'r .. T............. 19.... ., and approved by the Building Inspector. �J Fee$......................... . ............................... :ng Inspector Rev. 6/30/80 BOARD OF itEALTH . . . . . . . . . FORM NO. 1 j3 SETS OF PLANS . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . _ _ . . . . . . . . . . BUILDING DEPARTMENT _�/CIIECK . _ . _ AUG 1 4 1995 TOWN HALL SEPTIC FORA . . . . . . . . . . . . . SOUi-I-IOLD, N.Y. 11971 TEL.. 765-1I302 NOTIFY (� CALL 10 NA"zL To :1 O Oux Approved . . . . . � �. . . . ., 191J. Permit No. /c��o Z1. . . . . . . - _ . . . . .( . . . Disapproved a/c . . � - (Bu' dinb Inspector) APPLICATION FOR BUILDING PERMIT Date . . . .. . . . . . . . . . . . . . .. 19 . . . INSTIZUCTIONS 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 out 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- '�calion. c. The work covered by this application may not b.e 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 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 Iuilding 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,IlSt lding code, io sing"code'�and' regulations, and to admit authorized inspectors on premises and in building for necessary 'nspections. _ r, kni i! s £ . . . . . ... . . . . . . . ( ignature of applicant, or name, if a corporalior ) 1101 /. . (Mailing address of applicant) Slate whether applicant is owner, lessee, 'agent, architect, engineer, general con'tractor,`electrician, plumber or builder. NahRe of owner of premises S (as on the tax roll or latest deed) . if applicant is a corporation, signature of duly autlorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . ... . . . . . . . . . . . . . . . . . Electrician's License No. . . .. . . . . . . . . . . . . . . . . . . . 011uer Trade's License No. . . . . . . . . . . . . . . . . . . . . . I , Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ae-. . . . . . . . . . . . ':5q(AA.�I r� . . . . . . . . . . . . . ... . . . . . . . . . . . . . I ouse Number, (Street hamlet County Tax Alap No. 1000 Section . . . :1 . Block . . � . . . . . . . . . . . . . Lot .q)4'.L3. . . . . . . . . Subdivision . . . , . . Filed Mal) No. . . . . . . . . . . . . . . (Name) Lot ; . . . . . . . 2: Slate existing use ail_Occulzancy Of premises and intended use and occupancy of proposed construction,. a. Existing use and occupancy . . . . . &S . . . . b. Intended use and occupancy . . w . . . . , . , . . , , , p y _ • •�/mii Y'��F [�4�4• Yf>T r:r4;. n!. J^ta�if • • • • • • • • • • • • . . . -3. Nature of work (clieck which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . AlterationRebair . . . . . . . . . . . . . Removal . . . . . . . . . . . . . .. De.nolition , , , , , . , , , , , , , Other Work 4. Estimated Cost . . . . . N,/ O C� (Description) . . . . . . . . . . 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 . . . . . . • • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <. If business, commercial or mixed occupancy, specify nature and extent of•eaclr ty. p.e.of. use 7. Dimensions of existing stnrctures, if any: Front . Rear Depth . . . Ileigltt .. . . . . . . . . .. . . . . . " " . Number of Stories . . . • • • • • . • • ' . • • • • • � � • � • p " " . . . . Dir>>cnsions of same structure with alteration's or additions: front . . . . 1)el�tlr . . . . Rear . . . . . . . . . . . . . . . . . Ifeiglrt� . . . . . . . . . . . . . . : Number of Stories 8. Dimensions of entire new construction: Front . . . . . . Rear I-Ieigllt . . . . . . . . . . . . . . . Number of Depth . . . . . . . . . . . . . . . 9. sizeStories . . . . . . . . . . . . . . . . . . . . . . . . . .of lot: Front • • . . . . . 10. Date of Purchase Rear. . . . . . . . . . . . . . : . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . ase . . . . . . . . . . . . . . . .•. . . . . ... . . Narne of Fonner' Owner 1 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . , '3. Wil! lot be regraded . , , , , . , . . Will excess fill be removed from premises: Yes 4. Nance of Owner of premises • . . . • , , , , No . . . . , Address . Phone No. Name of Architect . . . . . . Address . Plione No. Nance �f ConlraclO1• Address • . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . 5. is Llil.s property within 300 feel of a L-idal wetland? *Yes. *If yes, Southold 'Town Trustees Permit- may. be required, No. . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from)roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. y. APPROVED AS NOTED DATE. B.P.# 7(0 FEE: _NOTIFY BUILDING DEPARTMENT AT 765,.1802' 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION &..ENERGY CODES. NOT RESPONSIBLE:.'FOR DESIGN OR CONSTRUCTION ERRORS':: PATE OF NEW YOW S.S JUNTY OF . . . �7 5 ,T * ! 7 V e. • • • `"•` . . • • • • . . . . . . . , being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) )ove named. CLQ is [lie . . . . . . . . . . . . . . . . . . . . . . . . . . . . tom'`(. . . . . . . (Contractor, 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 irk will be perforned in the manner set forth in the application filed therewith. vorn to before me this . . . . . . . . . 1�� . . . Y. o f . .us:.. . 19 S Mary Public, . . . . County ROBERT I.SCOTT.J NOTARY PUBLIC.Stat of N.Y. " . . . . . ' • ' • • • • No.4725089.Suffolk County (Signature of applicant) Term Expires May 31. 19p -y00,s' sc so: titi ^� FC. . 0 �. WOO �`� ^0 . .. - •. ... �o. \fir°, - n/. �S3 •sue P o'o.� L .. b jit- AREA = 15,630 s �3 .00 : .. �O. y r� F_ The locallons of wells and cesspools shown hereon are from field observations ELEVATIONS ARE REFERENCED and or from data obtained from others. TO AN ASSUMED DA TUU-�' -AUG 14 1995 S'