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HomeMy WebLinkAbout13228-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 13~8 Z Dote Permission is hereby grantee{ to: A , .:,,~..~~......~5 ................................. ~,~..~........b...,,..~.;....~..u~..~_ ............. ,, ~,..~,~ ~_,, ~,,.,._.. ~..;.~ ~ ~...~..~.. ~'o .................................................................... ................ ~.. ....................... ~.~. .......... ).._.. at premises located at '.~..~....b'...?.....~.......~,...~.,.....~~ ................................... ~uont to opp,icot,on dot~ ...... ~.L.~ ....................... , ~.~:~.. ond opp~¥~ ~y t~ Building Inspector. Fee Si. ..................... · .... Building Inspector ~v. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved · .I..~.., 19~.~. permit No. ] 25:}.~.~ ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERM IT Application No .................. INSTRUCTIONS a. This application must b~ completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 Occupa}tcy 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 buildings 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 ......... "'-~J~Sm^-' (-~ "' ~ ''~ ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· ' DATE: ~B.P. ', ~ (Name and title of corporate officer) Builder's License No ..... .~..~(~,, .~?' .............. Plumber's License No ......................... Electrician's License No ....................... Other T~ade's License No ...................... 765d802 9 AM TO 4 PM FOR THE FOLLO\,,v, iNG INSPECTIONS: l, FO/-Ihlr~ATION - TWO REQUIRED FO~ P~UR~D CONCR,?FE ~. ~SUGH.- F~M~NG & PLUMBING · . . ~, ~©N,~ 'L.TT~C~4' <.r~M ~ 1. Locabon of land on winch proposed work wdl be done ............ ~ ' ~'~ ,' E; ;" ' :': ; 'x ' "':',~''''': ....... ......................... ' ........................... Street . House Number ~1~ ~ ~'~ ~' CohntyTaxMap'No. 1000 Section ' .~&~ ........ Block ..... ~(?~ ........ Lot.....~}~ff ....... Subdivision ............................... Filed Map No ............... Lot ..... . .......... 2. State existing use and occupancy of premises and intended use and °ccupancy °f:pr°p°sed c°nstructi°n: . .... a. Existing use and occupancy ............................................... b. Intended use and occup~cy ~"~/¢ ~(>' ~ ~¢ ¢*"¢' :''< "'''~ ........... o Nature of work (check which applicable): New Building .......... Addition .......... Alteration_ ...: .... :. Repair ........ RemoVal ...... ' ........ Demolition ............. Other Wgrk..~.~/?.cf.~.~ .... .... (Description) Estimaied Cost ......... Fee (to be paid on filing this application) If dwelling, number of dwelling ~nits .............. Number of dwelling units on each floor ................ If garage, number of cars ..... i .......................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing strncture~, if any: Front ............... Rear .............. Depth .............. Number of Stories '. ........ ' ............ Height... . · . ........................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth .................... i. · Height ...................... Number of Stories ................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Nu,mber of Stones . .... ............................... ;~.. f../~ Depth '~' ~ >'~?.' ~ ........... Size of lot: Front ... ~.7_.~/...i ........... Rear ................. ?':'~ ............ ' [)ate of Purchase ........... i ................. Name of Former Owner ........................... Zone or use district in which pr,raises are situated ..................................................... Does proposed construction violate any zoning law ordinance or regulation: ................................ ' Will excess fill be removed from premises: Yes No Will lot beregraded......:~................... .,~..~ Name of Owner of premises ~.¥ /~.o.t?.~ ......... Address ..................... · ' Phone No Name of Architect ......................... Address ................................... Name of Contractor ....... ~ ................ Address ...... '. ............ Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, 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 said owner or owners, and is application; that all statements co work will.be performed in the man Sworn to :before me this STATE OF, NEg.,YORK, COUNTY OF .~qF(C. d.~./.~ ...... S.S ........ ~. c:/?. C~./f.....~'.-...../../.~.-~./../?.~.~.C.d? ........being duly sworn, deposes and says'that he is the applicant (Name of individual si ning contract) above named. Heis the ........... .~./~. '~"~' ~ ................................................................. (Contractor, agent, corporate officer, etc.) uly authorized to perform or have performed the said work and to make and file this ~tained in this application are true to the best of his knowledge and belief; and that the ~er set forth in the application filed therewith. COmmission ~r~ Ma~ ~, I