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HomeMy WebLinkAbout13554-zTOWN 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) NB 13554 Z Permission is hereby granted to: ................ County Tax Map No. 1000 Section ....... ]..~...~.. ...... Block ......... ~ ........Lot No ........... ...L~. ......... pursuant to application dated (~..~....~....~..~.. ............... , 19..~....kj., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 0 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .~..~ .~...~..o.., 19~. 9. Permit NoJ..~.~..~.~. 9...;~. Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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. 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaryfi~ections. /D ~ ~ .......... ~Signature of applicant, or name, if a corporation) ....... 1.7 : . (Marling address o f a~C~~¢5 ?~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~./· .~~. J~. :. · ~ ........................ ~'//.yff.. (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title:of corporateofficer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ..................... w.,. ................ ..... House Number Street County Tax Map No. 1000 Section ..... [ C) Block .. ~ D_ Lot ~ ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ..... ~ ~ ..u~.. ................................ 3. Nature of work (check which applicable): New Building ..... ' .....'Addition..i ........ Alterati9~ .......... Repair .............. Removal .............. Demolition ........... ~... ~ ' I (Description) 4. Estimated Cost ............ · ...... Fee ~ . ........................ (to be paid on filing this application) 5 If dwelling number of dwelling units Number of dwelling uni!s on each floor If garage number of cars 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... >~i pth 7. Dimensions of e sting structures, ifany: Front ............... Rear ....... i ....... De ............... Height ............... Number of Stories ............................ i ............................ 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 .i ........................... 11. Zone or use distriq.t in which premises are situated ......................... ! ........................... Does proposed co~truction violate any zoning law ordinance or regulation: 13. Will lot be regraded ....... ,./ ......... ,,~. ,~., .... Will excess 311 be removed from premises: Ye Name of Architect . 't'f ',M' ' ' H 7)' · ~ .......... Address .................... Phone No., ....... ~, ...... Name of Contractor ~ .~./~.~q('q--~ddress ................ Phone No~?'/~'. PLOT DIAGRAM 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. · APP~©YZD AS NOTED DAT/: . . ..... NOTJFY BUILDING DEPARTMENT AT 7654 802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, F, OUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3., INSULATION 4. FINAL - CON'STRUCTION MUST BE CqMPl.ETE FOR C, O. ALL CONSTRUCTION SHALL MEET THE REOIHREMENTS OF: THE N.Y. STATE CONqTRUCTION & ENERGY CODES. NOT RESPONSIBLE F~R DESIGN OR CONSTRUCTION FRPC~,~S, / STATE OF NEW//YOR. K, COUNTY OF~ ..... .~..; .~f.i~l~.sii~i~.c,o~};~c.ti .......... being duly sworn, deposes and says that he is the applicant 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 8aid 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 bef6re me this