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Home My WebLink About13430-z I~O~.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13~30 Z County Tax Map No. 1000 Section ......(~...01.....~J ....... Block ...... ..(~.....~ ........ Lot No.....~....'~....J ......... pursuant ,o application dated ...~.~~......~. ............. , 19..~...~.., and approved by the Building Inspector. ~ee ~ Rev. 6/30/80 ~ · 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~t)., 19 Approved ..~~ Disapproved a/c ..................................... .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the BuildLng 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 Ybrk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remora[ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, b. ui~lding code, housing code, a~ regulations, and to admit authorized inspectors on premises and in building for nec~Sa~ in~ctio/~ c~ -~,,~. ~)~ /, ....... · ............ (Signature of applicant, or name, if a corporation) (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 ..~):'~./~.~ ......... ~..~. /~.~- ...~7/.~,~.'.Q~.. ~ ..................... (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 ...................... I. Locatio¢of land on which proposed work will be done~¢,~ ................................................ Hamlet . }louse Number Street Subdivision ................................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of prop°sed constructi°n: a. Existing use and occupancy .. ~ .~c...C'~.../~ .................................................. b. Intended use and occupancy ........................ .._:_.~_.~ ......................... ~h' ~ ' .... tlo~n' ' mh apphcable). New Building .......... Add~ .......... Alteration .... .. ,~ ..... !l. RemoVal ........ ClY~iSliliaa~ Other Work ...... '* ' (D ription) :~ ...... ; ......................... Fee ....A..'~. .............................. '; '" (to be paid on filing this application) 5. I~fdwelhng, number:ofd~valhngunlts. ............... Number of dwelling units on each floor ................ If garage number of cars ~ 6. lf business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurel, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... 1 . Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrcction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ~ Rear Depth Date of Purchase ........... I .................. Name of Former Owner ............................. Zone or use district in ...... which pr~mlses are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ...... _...,'.. ~ ..... ~ ........... Will excess fill be removed from premises: Yes No Name of Owner of premises '.I~c;-'~....~.u. ~.. Address ................... Phone No..'7.%.~...~..o~..2~... Name Of Architect" Address Phone No Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether 11. 12. 14. property lines. Give street and block interior or corner lot. o' // NoTIFV B ~ LD N,G ~EP 765-1802 9 AM TO ~ PM 'FOR T FOLLOWING iNSPECTIONS: 1. FOUN~ATION ' TWO REOUIRED FOR p~URED cONCRET[ 2. ROUGH - FRAMING 8, 3. INSULAT{ON M ~. FINAL ' cON'C"I'RUF"FI%N BE C~MPI rTE FOR C.O. ALL CONSTR~ICTION sHALl THE REOUIR[MENTS OF TH~ bJ Y' STATE coNSTRUCTION g' CODES. NOT REsPoNSIB[ ~ DESIGN OR cONSTRUCTIO~ ERR~m* STATE OF NEW YORK, ,' COUNTY OF ................. : . being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above named. tte is the ' (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 ~e 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 ........... ~. ........... day of.. ~ ....... ,19... ~ ~IIHARY PUBLIC, Stale ~$ New York [ , , (Signature of applicant)