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Home My WebLink About13412-zTOWN OF SOOTHOLD B~ILDING DEPARTMt~NT TOWN HALL SO~THOLD, N. ¥, BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13412 Z Pen-nission is hereby gronte~ . . A · ~ ~..0...%.~ .................. ~ ........................... ~~.~....~.,.~ ...... t.L~.~l ......... ,o ..~.....~.'.~...-.~..~...~......~~.....~.....~... at prem,ses' located at ....1 ......... -~ ,~, ..,~. ....... ,,,,~...~.' ........... ~.~ ....................... Building Inspector. County Tax Map No. lO00 Section ...... ~..~ ............. Block ........ ~ .......... Lot No....~.,~ .............. and approved by the Fee $..,~..,~.....; ............ Rev. 6/30/80 · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined...~...~A~,...~...*.., 19i.~. Approved , · .~...'T~. · -~(~5., .~...i 19 ~. ~.. Permit No. [ .~.~..~.~..~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received~~,, .~.. ,19.~ Date..4.~trt~7~, · ....... 19~.~ a. This application mnst 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 Buildfl~g 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 throug~hout 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; Depfirtment for the igsfl/~ac~ of a Building Permit pu_rsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yt;j4~/a~ other appli.cable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~ ~v3~6val or demolition, as herein described, The applicant agrees to comply with all applicable laws, ordinances, buildJ ~.~, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~ '" i~ig~ta~''''//''~~applicant, ;; ~e~ i;; 'c;;~;[a~i~) .... ........ X. (Mailing addtess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ..~.~ ........... .17~....'{.. . .~ .~, .lr~, . , .~..~ ..................... (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 .......... r., ~./~ ........ Plumber's License No ..... '~' '/' /~]/// ......... ......... Other Trade s License No./...///. ............. 1. Location of land on which proposed work will be done .................................................. ........ .... ...................... ...................... House Number Street Hamlet County Tax Map No. 1000 Section ...... I..g~.~. ........ 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 ..................................................................... ~. ~ature of work (check which apPlicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition ............ Other Work. (Description) .'~/~.. ,t~,. ¢~ ----' Fee 4. Estimated Cost ................................................................ ! ~" (to be paid on filing this application) 5. If dwelling, number of dwelling un,its ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed o?upancy, specify nature an~ extent of each type of use .................... 7. Dimensions of existing structures, z~ 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 constructf.on: 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 premise~ are situated .................................................... 12. Does proposed construction violate a~ny zoning law, ordinance or regulation: ............................... 13, Will lot be regraded ............. ............... Will excess fill be removed from premiseg: Yes No ' 14. Name of Owner of premises ....... '~ ............ Address ................... Phone N~..-~-.~2- .... Name of Architect .,, .~.... t ..... ; ............. Address ................... Pho~,/i~.o ................ Name of Contractor . Address ................. r~l~fone No ............... PLOT DIAGRAM Locate clearly and distinctly all buildiflgs, 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. OF 6CCI] ,q C¥ STATE OF NEW YOR..~ ,.. COUNTY OF. ~0~..).J~... S.S .... NOTIFY BUILDING DEPARTMENT AT 7654802 9 AM TO 4 PM FOR TNE FOLLOWING INSPECTIONS: - ]. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Z ROUGH - FRAMING & PLUMBING 3. INSULATION ~ 4, FINAL, - CON'STRUCTI~N MUST BE C~PLETE ~OR C.O. ALL CONSTRUCTION SHALL THE REOU1REMENTS OF T~ ~ATE CONSTRUCTION & F CODES, NOT RESPONSIBLE DESIGN OR CONSTRUCTION ...... Ig.ql?~.T'...t~.r~//g.;.~:J'ja~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract above flamed. He is the .... '... CContra~tor, 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 the best application; that all statements contained in th!s application .are true tq j~f his knowledge and belief; and that the work will be performed in the manner set fOrth m the application filed therewith/ ~ Sworn to before me this Notary Public ....... ............... '!~,,. County gAR~.~R^ I~IACHU~ ' .................................. Nofarg Put>fie, Stat~0f New ¥or~ . [ (Signature of applicant) No. 52,4635190 Su'ffolk Coul~y Cemmlsslon Expires M~rch 30, 19~ r= k q'- ~- k