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Home My WebLink About13428-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13428 Z Permission is hereby granted to: , ........ ~.....~....~ ......... .7 ............... at premises located at ....~L..~..~.........~...~.....~:~'R~:t~. ......... ~ ...... pursuont to opplicotion doted ..... __a__ ...~..~......~... .......... , 19..~...~.,--" and opproved by the Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL · ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.~.. J O.., 19 .~.q · 19x Pewit No.1 Disapproved a/c ..................................... ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received 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. e. The work covered by this application may not be commenced before issuance of Building Permit. fl. Upon approval of this application, the Bnilding 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 i~ , ~' ..... ..... (Mailing address of ap~icant) ///q'q~ is/ow~lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder· State whether applicant Name of owner of premises . .~. ·.. ~ .~'7..~t(f.../x~. ~-.... ~ q../q.q.~ . .~w.W./../.~./. ........................... · ' ,/ (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 ...................... /O,,~& .~~ 1. Location of land on which ~'~'~osed work will be done ~ ~'~'' ~ ~ · House Number Street County Tax Map No. 1000 Section /.~.~ .~...~.. ...... Block .... 4 ............ 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 .... ~ ~--"~' '~' ' 'l .................... ,' ' '¥; ,~: ~ ' ,' ~,', ' '~; ............ 3. Nature ~fw0rk (qheqk ,~Jhich applicable): New Building ..... ' ..... Addition .......... Alteration ' Repair 1 .......... L.~ Removal ........... Demolition .............. Other Work..'....~ .~.... ' t.] > , ' (Description) I j lling ~nits ............... Number of dwelling units on each floor.. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ........................................................ D~ensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth ...................... HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................ . ............... 9. Size of lot: Front . .~. .... ........... Rear .. ~b~ .............. Depth ~; ............... 10. Date of Purchase ........... ~ .................. Name of Fo~er Owner ............................. ll. Zone or use district in which premises are situated, tq~ ................................................ 12. Does Proposed construction violate any zoning law, ordinance or re~lation: ................................ 13. Will lot be regraded ......... ~ ................ ,,.. Will excess fill be removed from premises: _ Yes No 14. N~e of Owner of premises ~~L~ Address ................... Phone No, ~9~[ ~ ..... Nme of Architect .......................... Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No ................ PLOT DIAG~M Locate cle~ly ~d dis~ctly ~l]bufldmgs, whether existing or proposed, ~d, indicate all set-back d~ensions from prope~y ~nes. Give street ~d block number or description according to deed ~d sh9~ street n~esA~dicate whether interior or comer lot. DATES~-B'P' ~ A ~V 765-1802 9 AM TO 4 PM FOR-THE FOLLOWING INSPECTIONS: ~' . .... , l. FOUKIrhATION TWO REQUIRED ~._ ~ n~ I~ ~- -~ FOq POURED. CONCRETE , ~.,,:::-~ 2, ROUGH - FRAMING & PLIJMBING 3. IN,'FIJI Am!ON 4, FIN^I CON'STRII~-IqN MUST BE C",M?~ F~rE FOR C. O. Rf%~AI_L ('~'~'"','-R'ICTION SHALL MEET THE Rr~' '~FMEN]"S OF THF N.Y. STA~F C~NqTRUCTION & ENFPGY CO~ES. N'hT RESPONSIB~ E F~A DESIGN OR CONSTRUC'FION ERRORS, STATE OF NEW 5~OP,,I~ g-/'"(Nan~e of individual sigffin~r~c-6~tract) 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 JUDITH T, TERRY '