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Home My WebLink About22230-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 22230 Z Permission is hereby grante.0 to: A wk��.... %q......1, �N-..... ............ V. ..l ..... P �... to ..../'Lf.0 /.7......... ............ .,... ? ........... � eJ. ..................... ...........Y. d...............0!� ...... ..X. . i....`, ..... .. ... `- "d....... ....... . .........<�!............. .................... ......v........,,., ..................... .................................................................................................................................................................. ........ ...................... .............. .................................. at premises located at............�.�s..�./.�, ..�....��.J........................... . . .�4-.... Cl ................. � County Tax Map No. 1000 Section ........ /......... Block......./ ............ Lot No. ................. pursuant to application dated .............. ..% .., 19..gr..... and approved by the Building Inspector. coo Fee$......................... ?Inspectior ..... ..... ...... Building Rev. 6/30/80 �; . � r• wr-�.......:ys.. -^4---�--..�� Ga.fi arc. } I } ANCN02 LANE ruLq F:c)T— TC2 DCQ' 37o. L�� N o. • lJnarthorrcd a'tar;•,.;n cr ad ii"ora 11 1 ! l tc t pis survey is a via;s':cn of i A -- IIt -�-( •r S Section 72[3 of the New Yof<Stags t } Education Law. + Coples of fhls survey map not bearing m the land surveyces Inked seal or � � {V ;, P. i4 embossed sea!shall nat be conaldcred � Q.Guarantees kx%MW Imam shin run 1 ` onry to the p®rsal tOrwfiom the survey Ql u.64 05'i0"�J. �08. 'Q ►s Prefiarad,and on his Behan to the title company,governmental agency and k t +lending lns6tu! ilstad hereon and I ,nQ 1 --- 'j o � to >:o -9sio•r-zes of he lending insti-C. nii. Cmu W. ro Lo-r N:1M�Ei�.S QEF+=w TO Nib JF . _ � �%,'tn4 aCu a HA�l34GZ ItGHTS 6ECrtON e.r1E , Ft�I;D tN t �6U i �' SuFF. CO. CLEKK'S 0FFtCE AS MAP No. 4 3n 5C1RVF'Y'E r02 r lo HT WI /� �P�orEL�' T''., THE' TITt.>= ,JAY .�� \ f . o,f aj SU2'di;Y � JULY �SFo tArao L10fiVSEO q.AtsjC 5—uv-,vEEY�.w 3l TITLE Nu. BOARD OF HEALTH D a M FORM NO. 1 3 SETS OF PLANS . . . . . . . . . .. 0 TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CIIECK 31994 ;j TOWN HALL SEPTIC .ORr1 . k SOUTHOLD, N.Y. 11971 73�43160• a E TEL.: 765-1802 TOWN� So 19� CALL Exam H ..�. MAIL TO : Approved . . . . . . . . . . ., 197.t(/Permit No.a,? ; :� . .: . . . _ . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . �f (Building Inspector) A P ICATION FOR BUILDING PERMIT Date. . . . ..7. I 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 diag cltion. ram which is part of this appli- 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 bee;: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 constructio_n.of buildings, additions or alterations, or for removal or demolition, as herein described. The 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 inspections. .i1 Q. . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) . g S. . . . . .?.C:.aw..t w . . . . . . - (Mai ling ing address of applicant) State whether applicant i owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. of owner of premises Nam . . . . .�. . . . . . S . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) ' If applicant is a corporation, signature of duly authorized officer. ti. (Name and title of corporate officer) Buif4r's License No. . a I qci L Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . .� sS. . . . . .c �. . curv�k t- .�1.�. . . . . . . . . . . . . .. IIouse Number Street t HamA County Tax Map No. 1000 Section . . .�. .l. . . . . . . . . . . Block . . . . .L . . . . . . . . . . . Lot . . . . .Q, , , , , , , Subdivision . . . . . . . . . . . . . . . (Na Filed Map No. Lot in . . . . . . . . . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . .. _e. . .vs . . . . . . . . b. Intended use and occupancy . Y 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . ." Alferati n"": Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition •C, . . . . . . . . . . Other Work--. , 41, " - (Description) (Description) 4. Estimated Cost ;. . .�.y ,,* . . . . . . . . . . . . . . . . . . . . . Fee .��.`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each 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 . . . . . . ::. . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height Number of Stories . . .AOW. . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . • • . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . • • Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . ... . . . . . . . . . . . . . . . Depth 10. Date of'Purchase . . . . . . . . . . . . . Name'of Former,Owner • • . • • 11. Zone or use district in which premises are situated ... . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation:' . .rl Q . . . . . . . . . . . . . . . . . . . . . . . • • �'13: Will lot be regraded. • . .rW• • . , . . , , , • , , , , , , , , • , , ,Will excess fill be removed from premises: Yes 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„ , , , • • • • • • • • • , *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM 4' Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from g1:l;ezty lines. Give street and block.number or description according to deed, and show street names and indicate whether. interior or corner lot. APp 0 ED AS DOTED DATE: 3 s.P# 29a30 F99: NOTIFY BUILDING BY. NT — 765.1802 9 AM TO 4 P FOR FOLLOWINGTHE INSPECTIONS: ' I. FOLINI'Ai'If?pa - -DjVo REQUIRED /FAIY")r',' PC)UIiir 0 CONCRETE 2.ALL _C®_ t STATE OF NE�Y ,OR / COUNTY OF . . . ..Z/t .(. S.S • • • • • • �• «•�• ! •�}-.• •v5. 1 `. �S .�. . . . . . . being duly sworn, deposes and says that he is the applicant�_(Iame of individual signing contract) above named. He is the . . . . . . . . . . . . . . .d.(,l.) 1'�,Q. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 the application filed therewith. Sworn to before me`this . . . . . . . . . . 1. . . . . . :day of. Notary Publi . . . . . . . County CLAIRE L.GL.EW •�• Noted►Public,48795Q5of New York . c��. . . . . . . . . . . . Qualified in ®cemb��$190 (Signature of applicant) Commission ExP