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Home My WebLink About13370-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL CONIPLETION OF THE WORK AUTHORIZED) ~,~r- z-.~ 19.'~.!. N? 13370 Z Date ......... I ....................................... ' ot premises located at ............................................................................................................................ County Tax ................ / ~ ...................... ~ .................... ' ~° ~ Map No. 1000 Sect~o~ ......J. Block Lot No...~. pursuant to application dated .~..~..I,,5~...~......!...~. .................. , 19.~..~', and approved by the Building Inspector. Fee $..]....~,,..: ........... ..................... Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 ;xamine~.. ~.~...~.q. .... 19 ~/l ,x, ~tt~X~ ~q 19gk{. Permit No. J..~..~.~. Xpproved . · ."~r':e~. · .~ .......... " )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .... .~//.'7. .......... 19~. ¥. INSTRUCTIONS · a lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a.~ T, his P_P2._~.~ ~t -lan to scale. Fee according to schedule· public streets sets o~ plans, ac~u,a~ ~,v b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. · · t be commenced before issuance of Building Permit· c. covered by this application may,n,.o . ~ .:.: .... a ~ ildine 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ' ............. £ ......................... Name of owner of premises · (as on the tax roll or latest d ) If applicant is a corporation, signature of duly authorized officer· .... (Name and title of corporate officer) Builder's License No .......................... ; Plumber's License No .................... k;!i Electrician Licens~ No .................... '~' '~] Other Trade's License No ...................... ~. ~ff_,~..~,...,~...~../~.:... ~. ................ ;. Location of land on winch pro posed work will be done S. ............. Hamlet .............................. Street House Number ' ~ ~..~... Lot...~.67./., County Tax Map No. 1000 Section · · ./-/..~'. t~} .... , Block ............... ............ Filed Map No ............... Lot .............. Subdivision ................ (iq'a~&) .... 2. State existing use and occupancy °f premises and intended use and °ccupancy °f pr°p°sed c°nstructi°n: a. Existing use and occupancy b Intended use and occupancy ................................................................... ''8. 10. 11, 12. 13. 14. Nature of work (check which applicable): New Building ' .... Addition ......... Alteration .... Repair .............. RemOval .............. Demolition ............. Other Work ............ ~'a-~ d~ ! ,~_~ (Description) Estimated Cost .2 ?..c<: ...... ~ ......................... Fee .............................. .i '" (to be paid on filing this application) If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars ' If bumness, commercial or mixer occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth Height' Number of Stories Dimensions of same strncture with alterations or additions: Front Rear Depth , Height Number of Stories Dimensions of antire new construction: Front ............... Rear ............... Depth ............... · Height ............... Number of Stories ........................................................ Size of lot: Front .......... i Rear Depth ' I Date of Purchase .......... ~ .................. Name of Former Owner ............................. Zone or use district in which pr~mlses are situated ..................................................... Does proposed construction violate, any zoning law, ordinance or regulation: . ..................... ... ....... Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ..;' Address Phone No Nam fA hit ct ~ Add PhoneN e O rc e ......... ~ ................. tess ................... O ................ 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 number 9r description according to deed, and show street names and indicate whether property lines. Give street and block interior or corncr lot. STATE OF NEW YORK, i S.S COUNTY OF .................. DATE, S_._~B.p. :~ /~.~,~.b ~,~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINAL - CON,'STRUCTION MUST BE cOMPLETE FOR C.O. , ' ALL CONSTRLICTION SFIALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE" FOR DESIGN OR CONSTRUCTION ERRORS. ............................ 4 .................... being duly sworn, deposes and says that he is the applicant ! I (Name of,ndlwdual slg~ng contract) : above named. He is the i (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 in the application filed therewith· Sworn to before me this · .' ..... 9th. day qf...A.u. 9.ust 19 84. ' 9u~l~'fiad ~O~mmlsslon Expires March 30;