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Home My WebLink About13616-z FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWH HALL SOUTHOLD, N. Y. BUILDING PERMIT ~i'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ? Permission is hereby granted to: .1..o...q..o........~2.....~.....~.. .......... ...~, . ...~.... ~.. ,o .....~.~.....~.....(,...=' ' u.o.......~.~......~,~.....~...~...;~.~- ' '~"-- · . C. ~,~,~, ~' '~...V.. ......... ............................... ............... ................ et premises located at ............................................................................................................................ County Tax Map No. 1000 Section .... ..~...~...~.. ....... Block ....... ~ ......... Lot No ..... ..~:'...~. ............. pursuant to application dated ...~..,...~:..~*:~.~......~ ..................... , 19.?...~.., and approved by the Building Inspector. Building Inspector Rev, 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'IOLD, N.Y. NOTICE OF DISAPPROVAL . .?. .~., . . .~.~. ~ .... ~. .7. .~ .......... · Z-(~./.-2','?.'~,<_i, .-. ~.~ .... PLEASE TAKE NOTICE that your appl~on 0ated ... ~.. ~ ....... ,19 ..... for pe~it to construct... ~. :~... >~~...~C~ ................. at Stroot r ~ Hamlet County Tax Map No. 1000 Section .. O ~ ..... Block ...~ ....... Lot .~A ...... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following gromlds .'~~... [~.. ~ .... C...~ ~ RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ 19~.q.. Permit No ............ Application No .................. Disapproved a/c ' (Building~lnspector) .. . ~. ~ APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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. Upon .approval of this application, the Building Inspector will issue 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 Occupahcy 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 the Building Zone Ordinance of tho 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. · .7'..~/.~.. ?.o../3..~ .... .~..c~/.c.~..~.o: ..,~..~.k .,<.-~. !.&.& ~... (Signature of applicant, or name, if a corporation) · .~.q ~../-/.P.b..../YZ~T.I '~.. c../d.. AL t././1. 5~.~..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~. ~t~-~-~ · · .~.~..~.zcY~..~.~. · .~-~. ~~.) ..... .. .r _ ._~._ '('a~ ~'n the tax roll or latest deed) ~ ~/.D. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.....'.'~. · .g. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................... . .............................. ............. . °r'r House Number Street Hamlet C;6nty Tax'Map 'No. 1000 Section '..~ ........ '. Block ....c~... - ..... Lot...c~.. [ ...... : ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy·... I .'~..t~..~....~ .............. ~ ................................. ,. .: ,, b. Intended use and occupancy ... ,~ ............... ~. ,,:. ~...,..: ,~-,~, .... ...... , ....... 3. Nature of work (check which applicable): New Building .......... Addition .... ....... Alteration .......... Demolition ' Other Work Repair .............. Removal .......................... '. · ' .............. ' '~-- (Description) 4 Estimated Cost ................................................................. · (to be Oaid on filing this application) 5. If dwelling, number of dwelling units.......... ..... Number of dwelling unit~: on each floor ................ If garage, number of cars ............................................ * ........................... '6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... ' Depth 7. Dimensions of existing structures, if any: Front ............... Rear ....... L ..................... Number of Stories ' Height ....................................................................... · . ' · ' ' Front Rear Dmaens~ons of same structure w~th alterahons or add~ho s.n · . ................................., Height Number of :Stories ' Depth ................................................................., D~mens~ons of entire new construchon: Front Rear , Depth Height ............... Nu~rb~r of Stories ....... .,., · ~... j. .................................... Name of Former Owner . 0. Date of Purchase ....................................................... district in which premises are situated I. Zone or use .................................................... 2. Does proposed construction violate any zoning law, ordinance or regulation .... ~ ............................ ' ' Yes No 3. Will lot be regraded ............................ Will excess fill be removed, from premises: 4. Name of Owner of premises .................... Address ............... ,i .... Phone No ................ Address i Phone No Name of Architect .............................................................. Name of Contractor Address i Phone No · .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ~roperty lines. Give street and block number or descnphon according to deed, and show street names and indicate whether nterior or corner lot. ,~ t/n r~ ~/~-~ d~' o~ j~P,,~, ~O AS NOTiED NOTIFV B~.H[ DING DEPARTMENT AT 765-1802 9 AM TO 4 PM ,FOR THE FOLLOWING INSPECTIONS: ~ 1. FOUNDATION - TWO REQUIRED FOR P~URED CONCRETE 2. ROUGH - FRAMING & P~UMBING 3. INSUI ATION ~ C F~N~ . c~N%TRt)CTI0,N MUST BE C~)MPLETE FOR C.O., ALL CONSTRUCTION SHALE MEET THE REQt,)IREMENTS OF ~HE N.Y, STATE CONSTRUCTION &l ENERGY STATE OF NEW~OB v, .~ / . COD~S.t NOT RESPONSIBLE FOR s.s . CONSTR CT'O ........ /~4.. ~.. ~e C.~ CF O ,. being duly sworn, deposes ~d says that he is the applicant (Name of individual si~ing contract) above named· He is the .............................................................~ ............................. (Contractor, agent, corporate officer, of said owner or owners, ~d is duly authored to perfom or have peffomed the[said work ~d to m~e ~d file this application; that all statements centred ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set for~ ~ the application filed therewith· Sworn to before me this ........... ...... , . Juo . ~W Publl~ ~ ~ New Yo~ . F. ~ ~ ~..~...~ ..... ... .~.~ .... : .... ~ ~' ~ 8~ ~un~ , i (m~atu.~ ~f apphc~t) ~ ~ ~ ~, 1~ ,