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Home My WebLink About13572-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y, BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) NB 13572 Z Permission is hereby grantedA~: ,,~ ~ ,,,,, ~ ,~ "-.."i'~..o..,~...~ ............................... :: ................ ......... to ....................................................... 1 ........................... ~'~ ............ ZJ' ............. at premises located at ./. .................. ~.. co-.w Tox Map No. ,000 S,c,io, ....... !...~....0.. ..... ,l~k ........ .& ......... 'or No ...... .~..~ .......... pursuant to application dat~ .~.~.......~...~."~.. .............. , 19.~...~.., and approved by the Building Inspector. Rev. 6/30/80 ~'~" :~ '1~0 F SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined · .~.~:~'~..&-.}.., 19 .~.~. Approved ~°~'"~ ~'1 19~tj Permit No./. -~&~7°~ ~-- Disapproved a/c ..................................... TOWN OF $OUTHOLD, l:lec e :Lye d ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. 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, OrdLnances or Regulations, for the construction of buildings, additions or alterations, or fo~/r~moval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build',m.~ ~ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect~oJ~sf ~ _ ./; ........ . ............. (Signature of applicant, or name, if a corporation) ............ .... t.. q.>...'...: .... (Mailing address of applicaut) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 ...................... Name of owner of premises ........ D.$g.k.e.r.s. 9.n.,.~.q .C.a.r.~.hy..~..$ .m&~.tl .... (.p.g .r.'cp.e.r..s .h.J_~.) ................. (as on the tax roll or latest deed) AP~?~?:~ AS NOTED NOTIFY ~.1 ~!LDING DEPARTMENT AT 7~5-~07 9 AM TO 4 PM FOR THE FOL[ O'U!NG INSPECTIONS: 1. FOUhl:'/Yt-!ON - TWO REQUIRED FOR p'~tJr~.D CONCRETE 2. ROUGH - FRAMING & PLUMBING 4. FINAL - COh:$T,~UCTION MUST BE C~',MPI F-iT FOP. C. O. · . ALL CONSTRUCTION SHALL MEET 1. Locatio~ of lan~ en which proposed work will be done .... ~' '~.' · · ~ ~tJ~ · ~^,",~?~;r:'~-+~: AH,W,';,: ' ~:r'~, ......... "'' '~'' ':''~ ~ .... '~ ............... '-'r'': ............ Cb'I~I:S'," J~l :[~ESPONS~'BLE 'F~I~ ........ rtouse L'qumber I ~t eer DESIGN OR -~,.,~m~TRUCTION ECRORS. County Tax Map No i 000 Section .... J..~..~. ...... Block ......... ~. ....... Lot ..... ~ ¢ ........ 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...(.~.gki l:[.[/'~'. . .~.V~.[.(...C.~.~(.¢.c'.~.'~ .tJ~.. :~)..~.~..~)C.(.'.cL~[.~c[. ....... /~ 6~[~.~ b. Intended use and occupancy ..... . .~..~,...~. ~..x~.. ................................. ~-. ..... ' ; i 3. Nature of work (check which applicable): New Building ...._________________l~\ .... Addition . .! .AK...~ Alt re'F~flon K..Yx ....... P'-N .... Removal .............. Demolition ........... ... Other Work ............. Repair ...... ~ ,.~: (Description)' 4. Estimated Cost . .~)~ .. ~>~ .................. Fei .......... ........................ ~ .... " (to be ipaid on filing this application) 5. If dwelling, number of dwelling units ............. Number of dwelling units on each floor ................ 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 . . i D pth Height ............... Number of Stories ............................ ! ............................ Dim si f tut with It ati dditi Front Rea · en on8o sameStruc e a er onsora ons: ....... i r ........ Depth ...................... Height ...................... Number of Stories ..................... 8 f F R pth · Dimensions o entire new construction: ront ............... ear ..... ! ...... De ......... Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... iDepth ..................... 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: 13. Will lot be regraded ....... ,; ........ .-,... J ..... ' ' ' · ~ra/Wdl exc£ts fill tt~,~em~.v~l~frrlm premises: No 14. Name of Owner of premises '~'11~ .~,. ~.Lc[£~0:v~ .-P/ddress . [V~t~A. ~. D[~kPhone No.. ?.~.~.~'~ .~0. O .... Name of Architect ........................... Address ............... , ....Phone No ...... ~ ........ Name of Contractor Address 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 shoo street names and indicate whether interior or corner lot. STATE OF NE~[0 { S S ., COUNTY~OF' ~ ~k~ ....... ' '~ ......... .................. ,wo,n, (Name of individual signing contract) : above named. He is the ................................................... (Contractor, agent, corporate officer, etc.): of said owner or ownem, ~d is duly authorized to perform or hate performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of ins ~owledge and behef; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me, this ~ ~ ........ 19~ ............ / ., :' "~A~ ~U~IO, STATE O~ N~ Y~ ~ ' ~ ,($~gfia~ur~of applic~t) Guallflefl In Suffolk ~0., No. 5~4510158 .~ ; ~ Commission Expires March 30, lg ~