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Home My WebLink About13399-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TO%V~t HALL SOUTHOLD, N. Y. BUILDING PERMIT fi-HIS PER~IT MUST BE KEPT ON THE PREMISESUNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13399 Z Permission is hereby granted .to: , ~ ,~ , . ........... ,~ . , I / ? ,~'~ at premises located at ....~....~. ........... ~....~-::~ ......... ~...)..~ ............. County Tax Map No. 1000 Section .../.....C~...G ........ Block ......... 3. ........Lot No ....... /..G~. ........... to opplication doted ..... ~~..~..~ ........ , 19...~....L~ and approved by the pursuant' / Building Inspector. Building Inspector Rev. 6/30/80 Fi~LD ~NSFECTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) _ ROUGH FRAME & PLUMBING I INSULATION PER N. Y. ,_ STATE ENERGY ~,ODE F~AL , ADDITIONAL COMMENTS: Examined ~.~...u'o..~...&..~..., 19~. t./. Approved ......... 3...~..~ 19~/. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Permit No...~'~.~..~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERI~/IlT 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 approva[ 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 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 . .~[..~.e .... ./.~?.~..~hO. [k~'.L.~ ........................................... (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 .................................................. ..... ................... ...... ................. House Nmnber Street Hamlet County Tax Map No. I000 Section ...... ./..C~.~ ....... 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 ...... " ~. ............ b. Intended use and occupancy .................................. 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repmr .............. Remloval .............. Demolition .............. Other Work ............... .~ff~fi ~ (Description) :4. Estimated Cost ...... . .......................... Fee .................................... , ~" (to be paid 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 .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth Height Nu ber 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 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ! .................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises . .I. Add Ph N ' .................. ress ................... one o ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No. ?. ?.~.'. ~.~..-2.5.~... PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or prr~posed, and, indicate all set-back dimensions from property lines. Give street and block number or interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. description according to deed, and show street names and indicate whether S.S ............................ ~ .................... 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 duiy authorized to perform or have performed the said work and to make and file this application; tt[at ~11 statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann~ ;r set forth in the application filed therewith· Sworn to before me this ........... ¢'~. ~..'~. · day oi Notary Public,..~i...~. FEi IN ~. DE V0£ N0iARV PO{]{-i¢, Slatk of N v York N0, 4701878~uffolk C00~tX .~ term E~res Marc{1 30, ............ County ,. ~,- ~~~~.~ (Signature of applicant)