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Home My WebLink About13387-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) N? 13387 Z Permission is hereby granted[xto ...~.~.~..~.. L~.4.~ ....... ~' ......... ~"'~ ................ D": ....... : ........ ot pr~ml,e, Io~at..d at ............................................................................................................................ County Tax Map No. 1000 Sectilafi-~...~,.~,l' C) .......... Block ........ ~ .......... Lot No ...................... l ~.' ~ pursuant to application dated ..~.l~,~....~.........'~....~. ...... , 19..~,.~.., and approved by the Building Inspector. Fee $ ........................ Building Insl>ector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ............ 1 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, 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 in building for necessary insp~C(~tion~. admit authorized inspectors on premises and (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .............................................. * ............................ (as on the tax roll. or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of 2~/~ officer) Electrician's License No ....................... Other Trade's License No ...................... A~_ . '-~,/~,,~'~,~'- ~ I. Location of land on which proposed work will be done...~./.P~'.///-~. ~. · .r ./,~.r//??.'~. 7¥ ................... ~.~.-~[ · v .............. (/Street Hamlet House Number County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed c°nstructi°n: a. Existing use and occupancy ~ ...................... ,,? e.,:~.3. ~:.~u~ .~W~9-.~.~..~t/ ............. b. Intended use and occupancy .~ ...... /-,~ 3. Nature of work (check which applicable): New Building .......... Add~tlon .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work i (Description) 4. Estimated Cost ............ I ......................... Fee ...................................... ] ~*' (to be paid on filing this application) 5. If dwelling, number of dwellingI units ... ~ ..... Number of dwelling units on each floor ................ If garage numbe~ of cars . 6. If business, commercial or mixeld occupancy, specffy nature and extent of each type of use ...................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth, ............... Height ............... Number of Stories ........................................................ 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 i Rear " Depth 10. Date of Purchase .... ' ...... ~ .................. Name of Former Owner ............................. 11. ' ....... Zone or use d~stnct ~n whtch premises are situated .. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 1'3. Will lot be regraded . ....... i ...... ,~. ·., ......... Will exes, fil~,~,/~moved from premises: Yes No 14. amc of Owner of premise .... Address ¢:w~c-~rr-~ ......... Phone No..~ ~.O~"o~,~ ~ ... Name of Architect ...... ~/ ........-..(,/ ......... Address ................... Phone No ................. Name of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly alI 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. DATE: ~B.P. ~"E ~ ~ ,--- BY: I-r-. : .-L.-~ NOTIFY BUiLDiNG 765-1807- 9 AM T~ FOLLOWING INSPE NOTEII 4 PM FOR THE I IONS: 1. FouNdATION ' TWO REQUIRED FOR poUP.~D C ~NCR£TE STA~ ~y~ING & PLDMBING S' UST _..__ of said owner or owners, ~d is duly autho~zed to perform or have perfo~ed the said work and to m~e ~d file ~is application;that all statements contHned ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~m r set forth ~ the a~plication filed therewith. Sworn to before me this, · I~qtPublk~Smte ofNowVork ~ ~. ~ / / ~ignature of applicant)