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Home My WebLink About22281-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 — N2 22281 Z Permission Is hereby granted to: 4 .......%�s ..... ................ ......... . .�✓ ............`Nny....... to ...... �. � ....... �d�.......icy"C ....... 4; .p. ....................................... ........o .. ...........�K l s!...�f2/�{�....... ...�xo..� ...� .1 �.�... . ...... -�.a ....... ., ...... .j . .e .. yr.d. ..-............................................................ V .................................................................................................................................................................. ...................................................................................�j............................................................................. at premises located at..........�..� ........� S/�;.e:��... ........................................... ............................................�. ie X/ o .......... . /," ....... County Tax Map No. 1000 Section . ..... ............. Block........;................ Lot No. . .......... pursuant to application dated ............. - - - ....... ......... ., 19.9 ......, and approved by the Building Inspector. Fee $. ✓, ....... � n .......... .. ... ............ ............... ...W......I...... ......... ............ Building Inspec or Rev. 6/30/80 - 7�s .140 d4FORM NO. 1 BOARD OF 11EALT-11 . . . . . . . s 3 SETS OF PLANS . . . 2 5 199�� TOWN OF SOUTHOLD SURVEY . . _ _ _ _ _ _ . _ . . . . . . i� BUILDING DEPARTMENT G11E`CF: . . . _ _ . _ _ _ , . , . . _ . BLDG.DEPT. TOWN HALL SEPTIC FORK . . . . . . . . . . . . TOWN OF SOU HOLD SOUTH OLD, N.Y. 17971 rl TEL.. 765.1802 NGTI FYExamined . . 19 �� CALL . . . . . - - - - - - - • . . . • MAIL TO : Approved � . . . ., 19/. . . Pcrmit No. .�0.� . . . . . . - . . . . . . . . . . Disapproved.a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - . . . . . . . . . .... .. . . . . . (Building Inspector) P CATION FOR BUILDING PERMIT Date . . . .. . . . . . . . . . . . . . 19 INSTRUCTIONS a. 'This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stiee or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app.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 perm 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the.issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances e Regulations, for the construction of-buildings, additions or alterations, or for rem 1 or dem 4tion, as herein describec The applicant agrees to comply with all applicable laws, ordina>ec5ildi ho ins e, and regulations, and t( admit authorized inspectors on premises and in building for necet . . . . . . . . . . . . . . . . . . . . . . . . . . . atplicant, or name, if a corporation) �`":.,,... • . (Mailing address of applicant) State wh.ethcr'yappIicant"is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . . !:?7w y . . `.`. .� /57��/ �rs`Je . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street . . . . . .... . . . . . . . . . . . . . .. Hamlet County Tax Map No. 1000 Scction3 Block . ... 4, , Lot . . _4-S. • . • • • . . Subdivision . . . ��i��.(!� �/lO,��f �(�Z� . . . . . . . . . . . . . . . I filed It1ap No. . . . Lot . . .3 (Name) . . . . . . . . . . . . . . . . 2-. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . :. . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . ./.)?�j��a4C' ,�Xr$��i(/C/ Pit(C� /d_ . _ I . . �'. ..• .• . • • - . • . 1 ®v�,� {,�®Lf 3. Nature of work (check which applicable): New Build Repair . . . . . . . . • . . . . . Removal ing . . . . . . • . • . :Addition . . . . . . . . . . t'Uteration . . . . . . . . • • • • • -- - •- - - Demolition . . . . . . . . . . . . . . Other Work . 6-0 4. Estimated Cost . . . .,�/C©. (Description) S. If dwelling, • • • • . . . . . . . . . . . ... . . . . . . . . . . . . . . Fee . • - ' •(to•bcpaidonfiling•thisapplication)• • • • • • . .rtg, of dwelling units . , , • • If garage, number of cars • • • • • • Number of dwelling units on each floor . . . . 6. If business, commercial or mixcd.occ • . .upancy,' • specify nature and .. . . . . . . . . . . . • • • • • . . . . . . . . . • . . extent of-each type of use . . . . . . . . . , 7, Dimensions of existing structures, if any: Front . Height . . . . . . . . . . . . . r Number of Stories . ' . . . . . . . . . . . Rear. . . .... . . . . . . . . . . Depth . . . . . . . • . . . . . Dimensions of same structure with alterations or add' • • • • •'` . . . . ' ' ' ' ' ' ' ' ' ' ' _ ' ' ' • • . . . . Depth . additions: Front Rear . . . . . . . . . . . 8, Dimensions of entire new construction:Hight . . . . . . . . . . . . . . . . . . . . Number of Stories . . , . • ' Front Rear . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . 9, Size of lot: Front . . . . . . . . Rear . •.. . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • ' . . . . . . 10. Date of Purchase �� " " • • • • • • • • • • • . . . . . . Depth 11. Zone or use district in w}tich ' ' ' . ' ' • • Name of Former Owner . ' • • Premises are situated .12• Does proposed construction violate any zoning law, ordinance• . . • . . . . • . . . . . ' ' . • . 13. Will lot be regraded . . , or regulation: • • • • , • • • • • . • . . . . ' ' ' . 14. Name of Owner of premises . . - • • ' ' . . ' ' . . Will excess fill be removed from premises: •Yes Name of Architect . . . . , . . . . . . ' ' ' ' ' • • • •Address . . : . . . . . . . . . . . . . . . . Phone No. . . . NC Address Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . •Address " " . • . . Phone No. . . . . , 15. Is this property within 300 feet• of a tidal wetland • ,� . ' ' . . ' ' , • • • • Phone No. . . . . . *If yes,' Southold Town Trustees Per �• uirYes No. . . . . . . . . ' • • • • • • • • • Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or Proposed, and.indicate property lines. Give street and block number or description according interior or corner lot. to deed, andshow street namesand indicate whet ilKI0 V to 2 % 0 Z c?7�� /ys� P /�o� 7 AppiOV D AS NOTED A sP. �2 l CIA&- FEE.. ' BY NOTIFY BUILDING DEPA [ 765-4802.,9 AM TO 4 PM FOR THE o FOLLOWING-INSPECTIONS: i. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. RIOUGH - FRAMING & PLtJIV1131NG -.S. INSULATION 4- FINAL - CONSTRUCTION DUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SMALL MEET THE REQUIREMENTS OF THE N.V. STATFc. CONSTRUCTION '& ENERGY CODE& NOT RESPONSIBLE FOR 13rks�'!GN OR CONSTRUCTION EfIROrS TATE OF NEWW ' OUNTY OF �G. L.�Z_ , S.SS . . . . . . . . . . . . .�/�{ . . . . . . being duly swor (Name of individual signing contract) n, deposes and says that he is the applicant - )ove named. n is the . ... . . . • . ... . . .C' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (Con-tractor,.agent cor�oratc • • • ' ' ' . } 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 in this application are true to the I Gest of his knowledge and belief;and that the )rk will be performed in the manner setforth in the application filed therewith. :orn to before me this . . . . . . . . . . . . . . . . . . .day of. . . . Uf. .`I. . . . . . . .. 19 1?4 tary Pu ic, . . . . . �• County • CLAIRE L.GLEW Notary Public,State of New York . • . . . . . . • • • • - • - • • • • • • . - . -- No.4879505 (Signature of applicant) ' Qualified in Suffolk County .._. Commission Expires Decembet8,19 _ • o ps . � N !r 150-0 t (Y o n a a4 04 ��1 1 = t 50._ . S 6,' 3t'5a':w 1 vs j MAP ar La•r Homes l�o4e r'Ls� t t`Iur+►bc•'•s Shown+ Re4'er T•o�r.rt or5oty-r*Aok-r>, .Y GucuraN -�: {-o M�►� of EastGrr► ShorcS~ - , �'i�Sa o►sd G�saYa►t�ijCo. a��,f �:�c �;.ttc �,. #►ird in Itic 5vffotk Ccvv►ftf S�viKc�s P,a�ek�as �tlrvd�e.t Mai t1 CierK's OF4CC as MOP N= �4OZi - $�,ote 40'-S" ' _•• . ."..`. ... ~ - }t„ LS1.VanT'v�1�