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HomeMy WebLinkAbout22932-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) NP 22932 Z .................... .... Date .�............................. 19..��. Permission Is hereby granted to; A41 ... 7z ...... . ...�..... ............................... to .. ....... i✓ /_..........�7)-..........f ✓.../ .`. ...................... ............ ............ .............. .............................................. .................................................................................................................................................................. ..... ..... .... ...............................................I....... A� ................ ....... ............ .....................I........... at premises located at.......,1 ,?`�. �� ��=v� ....................... ........................................ .Yj......................................... , ........... County Tax Map No. 1000 Section ....... ............. Block......40/......I..... Lot No. ....®X............ pursuant to application dated ............ . ......?�.X............... 19....Y and approved by the Building Inspector. Fee$.. ......... ... ............... ,. �� ............................... Building Inspector Rev. 6/30/80 3 r _I . a1t��R�CJfs- _ FT ro _ SJP -- N IA =� AT - - -__ i ��I _r)1•e'J icy �:}='`r i'•1:l-�r-7[v' 'i� �`j,../� � I :',:i•ref rY•1!JNW TG'3 - •G wneq. n-.ais:.:Waif la:hi _ _ _ � ��a•�•mien dust r.�r> n r.�! ; _Y.IEDG£ d:rc lo;x'n•/•is I Fr wa fL ARFEA=13C7$R� - r: r I' I <1-. ,I , ;IEEE tiIQ'.T.f�Pi�LQ1J81 S �+ ' b•E.'r :i_. iur o F' .h�UL' ntvE. 3..1 C••[.; tTEED iQ'LOU.NS iST(-'AC r _-- - - F.r$C 1 N _"Clf h l`LEEf�_?D:T1CQfZ: .--LAQAKITPr �' CQJA�!MAP G rA _ �,. 4 s�. ii _ pit - i. 5L L2 c:irVr 77 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . _ TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765 1802 t;OT IFy CALL L L Examined . . . . . . `�. . . ., 19 `l HAIL TO : . Approved . . . . . . �. . ., 195�Permit No. .� ( �y . . . . . . . . . . . . . . . . . . . . Disapproved.a/c . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . (B ]d' a nspector) APPLICATION OR BUILDING PERMIT Date . . . ., 19 .�f INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 silts 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 oar 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 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, addithpps,•;or;al.terations; or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances 'b"uildin code housing code and regulations, and to pp g . P Y PP g. g g , admit authorized inspectors on premises andui--building-for`necessary--inspections: gnatur. 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. Name of owner of premises . . �:1 /. .'/. .�/. . 7./ ,�t� i1! . � . . . . . . . . . . . . . (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 o.f land,on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . Mouse Number St et Hamlet Comity Tax Map-No. 1000 Section . . . : . . < . . . . . Block . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2.. State existing use and occupancy of premises and'inttended use and occupancy of proposed construction: a. Existing use and occupancy . : S� . ... . gg f • r . . . . . . . . . . . . . . . . �• .fit,.F4' •'�•J i.: .t `��-:"„ 'j b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . .tl.ia ?„ e w...-.s`•,,t o�,C.�l�'T a l c.m t c,.: -3. Nature of work (check which applicable): New Building . . . Addition Repair . . . . . . . . . . ... . . Removal ' ' ' ' ' ' ' ' ' • • • • • • • • • • Alteratio . . . . . . . . . . . . . . Demolition Other Work . .lit®®D . . . . . . . . . . . . . . . . . . . . . . . . . (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 exte . . ' ' ' ' ' ' ' 7. Dimensions of existing structures,if an • Front . . . nt of type of use . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . Y• . . . . . Rear. . . .... . . . . . . . . . . Depth . . . . . . . . . . . . . . . Number of Stories Dimensions of same structure with alterations or additions: Front ' ' .- - . . . . . . . . Depth . . . . .. ... . . . . . . . . . . . . . . . Height Rear . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . ' ' • • . ' Number of Stories . . . . . . . . . . . : . . . . . . . . . .Height Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . 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, or. .dinance or regulation: 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . Address . Phone No. Name of Architect . . . . . . . . . . . . . . . . . . . . . . .. . . . Address . . .• . . . . • . • • ' • , • . Phone No. • • . • • • . • • � • • • • � . Name of Contractor . Address . Phone No. � ' 15. Is this property within 300 feet of a tidal wetland?' *yes. • " " ' • '1 *If yes, Southold Town Trustees Permit maybe required, • • " No. . . . . . . . , PLOT DIAGRAM f 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. ROVED AS(NOTED DATE. _1 B.P..# FEE�'9:52'--- BY: NOTIFY BUILDING DEPART ENT 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 STATE OF NEW Y COUNTY OF . S.S _ . . . . being duly sworn, deposes and says that-he is the applicant (Name of individual signing contract) above named. I-le is the . . . . . . . . . . . . . . . . . . . . . . .©cst?w 2 (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 nner set fortli in the application filed therewith. Sworn to before me this daQf . . ��L�. . . 19 Notary Public, . . . . . . . . C ROBERT I. SCOTT,J NOTARY PUBLIC,Stat�.Y. " ' " " ' • • • • • • • . . . . . No.4725089.Suffolk County.. (Signature of applicant) Term Expires May 31. 19Y_00