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HomeMy WebLinkAbout13381-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PEI:~,AIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13381 Z Permission is hereby granted to: ......%....~........?.~ ................ ...~.~.~.....~.~..~.~ .................................... ©...A~...~....~.:?~ ........ L/.?. ..~L~ ........... ~ ::::::::::::::::::::::::::: ........ :::::?.:.. ....... .... : .... ..... ~, ~,~ ,~o,~ o, ..~...~..~.~...:~...,.~.:~ .............. ~~_ ........... and approved by the Building Inspector. ~e ,..J.~: ............. ............. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approve~_~4~'. .~..~., 197.~. Permit No. ). '.~..~ '.~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received .......... ,19... Date .... .~///.~..0. ....... 19~./jr/ 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 stYeets 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 i~suance 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 necessary inspecti~_~_ (Signaiture' 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. N~me of owner of premises .... ~4~.~.9...~..,~... ~..~..~)....~..~..~../~ .~:.'. ................ (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 .................................................. · ./~.~.f....~o;~.~..o_~. ~..~..~..~-.. ..... ..~..~././,~.~.~e-- ............ ................ ~;,;'lJ/ ............ House Number Street County Tax Map No. 1000 Section ...~..~..~. ...... Block .... ~.. ........... 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 .... .~.~..-~.C.~...~. ~. ~..--7~.. ......................................... b. Intended use and occupancy ....... ~<~:~57./. · .~-~.~5..~ .~. ..................................... 3. Nature ofwotrk (check which applicable): New Building ..... ' ..... Addition ........ .~lteratlon .......... 4. Estimated Cost .................... Fee ~ '-' (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ....... Number of dwellin nit ~ If garage, number of cars ... ,~,<".-~. ............................................. iiiiii 6. If business, commercial or mixe:d occupancy, specify nat.ute and extent of each type of use .,~. ~'~ ............. 7. Dimensions of existing structures, if any: Front..,m~,<~. ,,~. . Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth: i Height Number of Stories 8. Dimensions of entire new const[uction: Front ............... Rear ............... Depth ............... !,t. eight ............... Number of Stories ........................................... ~-' ........... 11. n o use aastnct ~n winen premises are situated ......................... ;q ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~...-:c'(-~. ......................... Will lot be regraded ........ , ................... Will excess fill be removed from pxgmises: . Yes No 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 fr'om property lines. Give street and block'number or description according to interior or corner lot. 7 OF NEW VORi.7 /x, COUNTY OF.. ,.~'~..,~.J... ~-,~... deed, and show street names and indicate whether NOTIFY ~' m~ING ~EPARTMENT AT 765-1809 9 AM TO 4 PM FOR THE FOIJ OWING ~NSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR P~URED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSUI,AT~ON 4. FINAl. CON%TRUCTION MUST BE C~MPI ETE FOR C. O, ALL CONSTRUCT{ON SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, ............................. ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ' He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 manne~ set forih in the application filed therewith. Sworn to before me this ......... c~C-,/ ~ .day ot~ ~ 19JT~ ry , .. t.~. ~.-~ . County , HELEN K. DF VOE , NOTARY PtitlLtC, Slate o~ Nevtyor~ ............... No. 4707878, Sul~ot! ~tmlJg.~,~ (Signature of applicant)