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Home My WebLink About13434-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST I~E KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 13434 Z Permission is hereby granted to: .... ~.~.~....~.~.....~..: ......... ..~~......~....~,..l.a~: .... ,o ...... ;. ........... ..~.....~.~ ............... ~~..~. .......................................... ~.~.~.....r.~..,.~......~;..~. .................................. , ........... .,9 at premtises located at .......~.~...~..."..~, ........ ~..~.'~m.....[..~-Y..~.........~...~.....~ County Tax Map No. 1000 Section ..... L~....~..'~.. ...... Block ......... .~.. ......... Lot No....)....~....'...}. ....... ~u~,ont to ~pp,,~ot,o, ~ted ...~.~~......~..~. ........ . ,9.1.~, o,~ app,o~ed ~ ,he Building Inspector. Fee $...t ................... Buil~'~g Inspector Rev. ~730/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 7654802 Approved .... I..~., 19~..~. Permit No. ]..~.~..~..~.-~ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 Y6rk, 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~ns. /) · " i i' nature'U 'e: ..... ih"~¢;; 'ai~i~;is; ;~a~iica~/)' ~ ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. A[~'P~OYED AS NOTED ...c ............. , ....... : .... : ................... : .,. ......... :.D^,~:~:~.',;/ Name of owner of-remises [§e-~-~- v' ~ ~- .~ ]/J~ '~]' q' S?f'~' 'J~' · 'F'~[: J'q¢ :7~' ' ' 'BY .... ~'"';:' ' ' ' .................. ('a} 'o;, t'~e' ;a'x roll or la~:F~]~'l'NG 765-1802 9 AM TO 4 PM FOR If applicant is a corporation, signature of duly authorized officer. FOLLOWING INSPECTIONS: l. FOIJNDATION _ TWO REQUIRED .............................................. FOR POURED CONCRETE (Name and title of corporate officer) 2. ROUGH - F[~AMING & PLUMBING 3. INsULATIO×~ Builder's License No .............. : ........... 4. FINAL - CO%'5';'PUC-I:ION MUST Plumber's License No ......................... ALL CONSTC:~C'T!ON SHALL MEET TFIE REOi!!~rp..4~NTS OF TIlE N. Electrician's License No ....................... STATE CONSTRuCTIoN & ENERGY CODES. NOT ~[SPONS~BLE PO Other Trade's License No ...................... DES~N I. Location of land on which proposed work will be done ............... House Number Street Hamlet Cou.t~Tax~apNo. 1000Section ...~.../.~..f ...... .lock ......... 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.se an. occupancy ...~./~.~...'~'' ;"'I~'~L3 .... 5~~. .... .-. .... j...~. ~ ...... (~ r..~...F?..e.c. ~. ........ b. Intended use and occupancy ....................................... . ............................ 10. 11. 12. k ( hi ppli ) Additi Alt tio,.n Nature of wor check w ch a cable: New Building .......... on ......... era .......... Repair .............. Remgval. .............. Demolition ............. Other Work. ,C..e?..~..e-. .... 9 O (Description) Estimated Cost ....... ~ ....................... Fee ...................................... i *" (to be paid on filing this application) If dwelling, number of dwelling ~units .............. Number of dwelling units on each floor ................ If garage, number of cars i ' -. ,. .... :. If business, commercial or mixed occupancy, specify na~ture and extent of each type of use ..................... Dimensions of existing structures if any: Front :".. ~. Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... q.. Height ...................... Number of Stories ................. Dimensions of entire new construction: Front .... t/.O ........ Rear .... .~.~.; ...... i ~e';th . .~-.~ ........ Number of Stories Height ...................................................................... Size of lot: Front .......... i ......... .% Rear ...................... Depth ..................... Date of Purchase .......... i .................. Name of Former Owner ............................ Zone or use district in which prgmises are situated 7 ................................................... 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 ~' ,a97~- [ .c..-~...[O. qg~.q .D. Address qU. ?. /):,. .q .?. I. Phone No ................ Name of Architect ......... ~ ................. Address .................... Phone No ....... Name of Contractor ~.o.~e..~.~.;... ~,./.~. ~...~. .... Address ~/2 .~. ~?.~ .~.~..~.~..~. Phone No..~. ~.LC ...... PLOT DIAGRAIVI Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property l~nes. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. f.e.:, vo 6..e... ~J_J~ ,. t.t, STATE OF NEW YORK, ! S.S COUNTY OF ................ , being duly sworn deposes and says that he is the applicant (Name of individual sigqing contract) .,, above named. : tie 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 cont:ained in this application are true to the best of his knowledge and belief; and that the work will b.e performed in the manner set forth in the application filed therewith. Sworn to before me this : · .' ......../..~..~..i~1 _ ~/ ,~ ,,li""~"' 19'~'' ........ day o ........... , Notary Publ~;e.,., .,. .... ~.~,../,-~. U ./~.... County ' NOIARY PtlEILIC~ Slate ol No~ Yoi[~ ' ' : ........... : .... \ No, 4707878, $~k Co,lilts. ...... ~' , . (Signature of applicant)