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Home My WebLink About22944-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 .............. Z.y............... 19.9 N2 22944 Z Permission Is hereby granted to: ....... .......... ....... .y` ........................ !0P .... ....... ..... a� ........ .C�,.�. � ... ......... .................................................................................................................................................................. .................................................................................................................................................................. ...................................................................... . ................................................................................... at premises located at...........1 4L�..C� ......... .................................................. ................I....... .........................../..' K.41.......... ., .. `...................................... ... 7 r/ County Tax Map No. 1000 Section .......... ...d......... Block......... ................ Lot No. •.........•.•.•••••••••••••• pursuant to application dated ............. ....... - ...... 19.. ......, and approved by the Building Inspector. pe/ Fee$.. �,►•••... ............. .....!...... ..... ... ...... Building Inspector Rev. 6/30/80 BOARD ' OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF a . PLANS • • . TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CHECK . _ . _ . . . . . . . . SEPTIC FOR11 TOWN HALL - - - • • • • • • • • - • • d; f SOUTHOLD, N.Y. 11971 G.DE,T. TEL.: 765 1802 t;OT I F 1Eo�- Tp OF SOUTHOLD rr� CALL . . J . .1 .. . . . . Examin � . . ., 19 J MA I L TO Approved �� . ., 19�?J. Permit No. ,! . . . . . . _ _ . . . . . . . . . . .. . Disapproved a/c . . . . . . . (Building Inspector) AP CATION FOR BUILDING PERMIT Date .�uLy :2 . . . . . . ., 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 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. Upoii' 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 sliall be occupied or used in whole or in part for any purpose whatever,until a Certificate of Occupancy sliall 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, builda•' code, housing co, e, and regulations, and to admit authorized inspectors on premises and in building for necessary insp'ecti ns # -- (Sig• 'fuse. ap.paicant, or name, if a corporation) • • • • , • •.• • • • • • • • . • • • • • • • • • • . .;(M,ailii g address.of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general' con tracto,r,, electrician; plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. t y. . . . ? .t' �. "ti...:,.. . . . . . . . . . . . . Name of owner of premises . . . �1.�`l C . . . . ( .�!:�!. . '; °� 9 . . . . . . . . . . . . . . . . . (as on the"•tax`roll'or'1'ates`t deed" r "`' If applicant is a corporation, signature of duly authorized officer. -=: :.: : : >i: .;;? •:w.:,' ;u,,;;.;;.;. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . ... ... . . . . . . . . . . . . . . . . . Electric'an's Licenses No. . . . . . . . . . . . . . . . . . . . . . . . therrad Oe's License No. ./. )j. ... 1. Location of'land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � !a. . . . . . . . . r .f'l� . . . ,21�. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . Block . . . . . . . . . . . . . . . . . . Lot . . : :j. . . • . . . . . • • • . Subdivision . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) , 2.. State existing use and occupancy of Xremises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy ;.0,. { . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition Alteration Repair . . . . . . . . . . . . . . Removal . . . Demolition - " ' . . . . . . . Other Work . e.4,C: . . . . 4. Estimated Cost . . .11 . , , , (Description) . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . : .. (to be paid-on-filing-this-applicat=i-on) 5.- :If dwelling, number of dwelling units ;, , • , of d = Number welling units._on_eacli*. oor i If..gaiage, number of cars - 6. If Business, commercial or mixed occupancy, specify nature and extent of•eaclt type'of"use .-- . 7. " Dimensions of existing structures, if any: Front . . . Rear Ilei lit . . Depth . . . . . . . . . . . . . . . g • • • • . . . . . . . . . Number of Stories Dimensions of same structure with alterations or additions: Front . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . Rear . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front ' ' ' ' • : Number . . Stories . . . . . . . . , I-Ieight . . . � .//. . . . . . . Rear . . . . . . . . . . . . . . . CNC7� { •4 . Number of Stories . . . . . . 9. Size of lot: Front .,. . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rear. . . . . . ' ' Depth 10. Date of Purchase. .�`d? Name of Former Owner 11. Zone or use district in which remises are situated . . . . . . ... . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . � . :. . 0 13. Will lot be regraded 1110 . Will excess fill be removed from premises: Yes NO 14. Name of Owner of premises ®.�C d�-$Q��, Address 160 . ,� (e[�• , Phone No.7-3 Name of Architect Address Phone No. Name of Contractor r •( �,(� .� • . . . , , d� ' Address . . Phone No. , �(��F�. s . 15. Is this property within 300 feet of a tidal wetland? *If yes, Southold Town Trustees Permit ma be required. � � " • No. . . . .'. . . , PLOT DIAGRAM Locate clearly and distinctly all •'buildings, wliet}ier existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block,number or de interior or corner lot. scription according to deed, and show street names and indicate whether JL All APPROVED AS NOTED � ;�2, ! . 1 DATE: B.P.# •�..�.�-- U�� _. II FEE: — BY: —J I Nc)11FY BUILDING DEPARTMEN AT. 765-1802 9 AM TO 4 PM FOR THE- FOI..LOWING 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 CONSTRICTION & ENERGY CODES. NOT RESPONS113LE FOR �I DESIGN OR CONSTRUCTION ERRORS STATE OF.NEW YORK, y COUNTY OF . . . . . . . . . . . . . . . .S.S' ® � • • • • • • • • • • • being duly sworn, deposes and says that he is the a I'c (Name of individual signing contract) pP ant above named. He is the . ._. . (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 manner set forth in the application filed therewith. Sworn to before me this . day of . ., 19 . . . Notary Public, . . . . . • • • • !! . .. County CE M.WILKINS ary Public,State of New York • • • • • . • � . . . . . . . . No.4952240,Suffolk Count (Signature of applicant) Term Expires June 12, 19_. 7