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Home My WebLink About22988-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, 22988 Z Permission Is hereby grante to: ........................................................................................ s��" .. .�....................... '.... . ... ... ;11.......... ...- . . ...................................................... to ......��--... ............./�............ . ...........-s ..................... ... s......................... ................................................................................................................................................ ................................ ...... ....... "F ............. ... ...... ............. ........................................................ . ..................................................................................................... at premises located at...... a.? .......... ... ••......•••..................................................... .. ..................................... .................. . ............ County Tax Map No. 1000 Section ......�............. Block.......Df.... ..... Lot No. `s ..�.......... .. . 1..b�.I and approved by the pursuant to application dated .......................................................... 19.. Building Inspector. Fee$......................... ".� .. .. .. . ............................... Building Inspector Rev. 6/30/80 rIrLD INSPECTION REPORT UA•TC COMMENTS H IOl1Nf)n'1.-TON ( IS'T) I{ II I 11 =--- ----- --- � FOUNDATION (2ND) II �h I ROUGII FRAME & _-----.{{ ---- --- � PLUMBING I ------------------ I IN5111,ATION PER N. T. STATE ENER(,'Y GODr II -- II {I I FT.Nnr, I (� ADDITIONAL, COMMENTS: ----- — 6� I A -- ---- Fill 7 rrI BOARD OF HEALTH . . . . . . . FORM PO.. 1 3 SETS OF PLANS . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . AUG 221995 BUILDING DEPARTMENT C11ECK . . . . . . _ . _ . . . . . . . . . . TOWN HALL SEPTIC FORK ... . . . . . . . . . . . - SOUTHOLD, N.Y: 11971 - TEL.: 765-1802 I FY CALL . . _ . . . . . . . . . . . . Examined . . . . . . . . . . 19 !.� HA I L TO : Approved . . . . . .9,1, . . ., 19!>. . Permit No.��9�� . . . . . . . . . . . . . . . . . . .. . . . . . . _ . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Buil nef Inspector) APPLICATION FOR BUILDING PERMIT Date �J• . . . 19� 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 builduigs 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 wilt 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 IiEREBY 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, buil&o.d.e,' houshr ode, an regulations, and to admit authorized inspectors on premises and in builduig for necessary insp. . . . . . . . . . - n tur` f appl}can r names}fa corporation) '1 (Mailing addxe s f5. .phcan•-t) `� State whether applicant is owner, les ee, 'agent, architect, engineer, general contractor, Alfia �r.or:builder..1 {,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APPR A RPM Name of owner of premises DA. 60. (as on the tax roll or la t BY: UILDING DEPARTMENT AT.- If applicant is a corporation, signature of duly authorized officer.' 765-1802 9 AM TO 4 PM FOR THIt FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED,, (Name and title of corporate offi.er) FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Builder's License No. 3. INSULATION 4. FINAL 7 CONSTRUCTION MUST BE-COMPLETE FOR C.O. Plumber's License No. . . . ALL CONSTRUCTION SHALL MEET -THE-. REQUIREMENTS OF THE N.Y. Electrician's License No. . . . . . . . STATE CONSTRUCTION .& ENERGY CODES.. NOT RESPONSIBLE FOR Other"Trade's License No.� . . . . . . . . . . . . . . DESIGN OR CONSTRUCTION ERRORS 1 . Location of land on which proposed work will be done. . . . . . . . , . . , . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . Awl . . . . . . . . . . . . . . . . . . . . .�tircet . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . Ilo*use Number Hamlet County Tax Map No. 1000 Section . . �. . . . . . Block . . . . . . . . . . . Lo . . . . . . . Subdivision . . . . . . . . . . . . . . . . . .'. Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 1 State existing use and occupancy of premised and intended use and occupancy of proposed construction: a. Existing use and-occupancy . . . . . . (.X.I b. Intendeduseand occupancy . . . D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building Repair ' • Addition . . . . . . . . . . Alteration Removal . . . . . . . . . . . . . . Demolition . . . . . . . . • t11er Work . .'- -Y 4. Estimated Cost (Description) : ! . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .. Fee . . (to be paid on filing this application) S. If dwelling, number of dwelling units . .. . . . .r/�- - Number of dwelling units on each floor . ... . . : . . . . . . . . . . If garage, number of cars . . . . . A` ' . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . G. If business, commercial or mixed occupancy, specify natti,rp,�and extent of•eacI . . . . . . . 7. Dimensions of e �" Ype of use . ng structures, if any: Front �Height . . . , , . . . . Number of Stories . . . . ; : Rear . . Depth Dimensions of sail a nlctUre with alterations or ad�9/ ns: Front Depth . . . . . . . . . . . . . . . . . Height �� . . . . . . . . . Rear . . . . . . . . . . . . 8. Dime � ` Numb f Stories . . . . ... I1S10I15rn . new construction: Front Rear , , /�f- Ileigllt . . . . . . . . . . . . Depth . 1�€r of Stories .. . . . 9. Size of lot: . . . ��—,�- . . . . Rea . 7��. . . . . . . 10. Date of Purchase . . . . . . ./. �' �. . . . . . . . . . . De� Na F r Owner 11. Zone or use district in which premises are situated . 12. Does proposed construction ate . . ... c''•.+ any zoning law, ordinance or regulation: s .. 13. Will lot be regraded - . . ;•.� ,: .;.�.. p Will e, s 111 VIM r ,r�'iseIS! s 14. Name of Owner of remises / ✓7 , ,,. Addres o Name of Architectbrhe'�No' :Z'? Name of . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . Ph'on'e!' Contractor . 15. Is this property within 300 feet of al 'wetlann a tid Address . . . . . . . . . . . i",.a Pl one,h1o,. `g,. . t. . d? *Yes. . . . . . . : o *If yes, Southold Town Trustees Permit may. .be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,mdre�1e ilPset`b`Pkr dlmEnsiot s from Property lines. Give street and block number or description according to deed, and s1�ow street names and°indicate �v}Iet}Ier interior or corner lot. ' x 140 r TATE OF NEW YORK, Ou Y OF . S.S • . . . . . . being duly sworn, deposes and:says that he is the applicant (Name oViv, yfzl signing contract) rove named. CC�J ''�� - e is the . . . . . . (Contractor, agent, corj')orate' 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 ill tliis-application are true to. the best of his knowledge and belief;and that the ork w}ll be perfonned in the manner set forth in the application filed therewith. vorn to before me this . . . . . . . . r� �— . day of. . . . .. 19 )tary Public, ounty , . . . . . . . . . ;- ;� HEL.ENE 0.HORNE . Notary Public,State of New York (Signature of applicant.) No.4951364 Qualified in Suffolk bounty Commission Exiiires May 22, 19„�?