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Home My WebLink About22983-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.�..... NP 22983 Z 4.�V Permission is hereby granted to: � , ' C,�.-�1.'••;/ / %� .................. .. .> .�..�.... ................... . . ....... a ..... a ..�®. . .. ... . . .... ........ . .......4::5Z....., .- G ..... ..... .......... ............... ............ ` .......� . V..... .. - .. .. .. . ..................................................... .................................................................................................................................................................. ................................................................................................. ........... � ................................... at premises located at...Iom....... ... . ............:..................................... ....................... .................................. ................... ....................... ........................................ County Tax Map No. 1000 Section ............71..... Block........./............. Lot No. ��.7............... pursuant to application dated ................... &., ...... !�...... 19... and approved by the Building Inspector. Fee$... .... .... ...........• ...........� ..... ............... Building Inspe r Rev. 6/30/80 HOARD ' OF [IEALTII FORM NO. 1 7 SETS OF PL.\NS . . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . AUG 2 I 19% BUILDING DEPARTMENT CHECK . . . . . . _ . _ . . . . . . . . . TOWN MALL SEPTIC F0IM . . . . . . . . . . . . . -- - SOU 1 [[OLD, N.Y. 11971 TEL.. 765 1 302 NOT I FY' CALL 19,9 HA i i. TO - ° I I ro ved � �� e .'! . . . /4�df/L A ' � ` ., 19 . I'ennit No. . . . . _ . .Z .�. :/. 1. j�� Disapproved a/c . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . (Building Inspector) AP [CATION FOR BUILDING PERMIT Date . : �%.7 . .. . . . . . . . . . ., 19l�� 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 sliowin'g 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. r 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 be kept on the premises available for inspection throughout the work. " e. No building shall be occupied or,used in whole or in hart for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-IEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutliold, 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. 'I'lie 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 insnecti.on (Signature of a >>lica11 ov't�ame if a corporation . 11 1 ) (Mailiiig�lddress of r:pj licant) O(D�bS Slate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. L�LJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . , (as on the tax roll or. latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vwt�0. . . 7-0�.�'a . .. . . . . . . . . . . . . . Ilouse Number Street Hamlet County Tax Map No. 1000 Section . . . : .7./ . . . . . ... . . . Block . . . . . /. . . . . . . : . . . Lot . . . . . . %.7 . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) ' 2: Slatc existing use and occupancy of premises and intended u occupancy se and occu p y of proposed construction: a. Existing use and occupancy .�2 . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . ♦1 1 3. Nature of work (check w)uicir applicable): New Building . . . . . . . Repair • • • Addition . . . . . . . . . . Alteration _ I Removal . . . . . , • Demolition Other 1York . 4. Estimated d Cost . . . . . . �'�- r (Description) � e . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . .i .1. .`. ' . . . . . . . . . . . . . (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 extent of.each type of use . 7. Dimensions of existing structures, if any: 'Front . . ' ' ' • ' ' ' • ' Height . . . . . . . Rear . . Depth . . . . . . . . Number of Stories • , , Dimensions of same structure with alterations or additions:.Front. Depth . . . . •. . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . fleight , , , , , , , , , , , , , , , , , ; Number of Stories 8, Dimensions of entire new construction:Front. . . . . . . Rear Height . . . . . . . . . . . . . . . NumberDepth . . . . . . . . . . . . . . . of . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . Rear. Depth 10. Date Of Purchase . . . . . . . . • . . . . . . . . . : . . . . . . . . . . . . . . . : . . . . . . . . Dep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . Name of Fonner Owner . . . . . . . . . . I I. Zone or use district in which premises are situated . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . ./k/4. 13. 4Yi11 lot be regraded . . . . . . . . b. . 1Yill excess fill be removed fro n. emises: • Ill. Name of Owner of premises . . .k1.A�-,* ; . Yes No t�� ,,,T . . . . . Address . l�.��? ? � l�lioi� -, Address / 3. .�P S Name of Contractor . . . . Sf7.�F^!cI q.f o. .`��.y:/�o c, ilddress 1'Ironc No.15. l.s Lhi.s property within 300 feel of a tidal wetland? �Yes. .x. No. . . . . . . . . . . . . . j *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. t J, -- A RO E®AS NOTE® DATE- a.P FEE: Ile NOTIFY BUILDING DE P 755-1302 9 AM TO 4 T FOLLOWING INSPECTIONS: FOR THE 1• FOtJI MAXION - TWO REOUIRED FOR POURED;CONCRETE 2. Itit)t1GH - FR�n p,,\i6� 3. INSULATION 4. FINAL - CONISTnUCTION IMUCT BE COMPLETE FOF, t..C). ALL CONSTRUC-TION S4ALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTI().j 8, EPJV-�RGy CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTIOt4 ERROR±= TATE OF NE1Y YORK, '0UNTY OF . . . . S.S . . . . . . . . . . . G? . 4� being duly sworn, deposes and says that lie is the applicant (Name of individua signing contract) )ove named. e is the . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this rplication; 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 . . .day o . .� �`?'". . . . . . . . . . . . . .. 19 wary Public, . . . KX. . . . . . . . . . ounty HELENE D.kORNE• • • • • • • • . . . . . . . . . . zz�lC� Notary Public,State of New York (Signature of applicant)No.4951364 pp ) Oualified'in Suffolk County Commission Expires May 22, 19 `"_ti_ ..r: .�-' _ ': Ye: '�•'•. ••`,,fit, '� •._ • -� _ ra '- .,�-,: .. ,i'A,�,•t,•. ^ram -,. .'f 1.1 j 82 30-00 F.. -' 317.09 �:t: �*£'�_ • " 1' : ptet�•�- ItCTC. �� •�� :�� LL elf 40 Or- LAUr v: �utzvc.Yra FcQ •.+y,- � �{ 4` �� •� Y;.�kn��. r.�<. ,. 't-fin :..A,:,• ti _ 1 -� :5.0U TWO Lb. PT Lj ,•11}..y'M-+4C��(BN� �� '<"' ',� .t. � y�:~� 'C •tom � �� !' - _t�