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Home My WebLink About13233-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N°, BUILDING PERMIT (THIS PER/RIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~te. '~.~..)3 ....... ,9..~.'.f ls~3s z '"fl ............................... Permission is hereby granted to: ....................................... · '<.--..., .Q...,:?a. ............. .~.,'... ...~.~..~..~.~'. ............................. ,o .............. at premises located at ..)..~.. ................ ~. ................... ~:/[ ~ . ~~. ~' 0 ~..,.,~ ~,..,.~ e_,~a ............. County Tax Map No. 1000 Section ...... ~....~...~ ....... Block .......... .~ .......... Lot No...[.'~-...~...~. ......... pursuant to application dated ......... ..~~..~...~.. ................. , 19.~.L~..., and approved by the Building Inspector. ~v. 6/30/80 Examined . Approved . FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 .~..~....I. ~ ..... ', 19 ?.~( · J..~. .....19~.~. Permit No..I.'.~..:)r'.~..~. ~ Application No .................. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 build/rigs 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 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 inspections. ,-.. ~. o..~.~. ~..P. o~ ~ 1 .~ .~ .C.0. :.t..~. ~: ........ (Signature of applicant, or name, if a corporation) v.i .¢. ¢., .%? ,o.! (Mailing address of applicant) State whether applicant is owner, lesse, e, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ~:,~. ~ Co-~. N~eofowne~of~remis~s ..... ~.~.!.~- .... .V.~:?.~.~:~.X~.'.X..~ ..... .~...~..H..~..5.~..~..°.~.:.~..*..~). .... (as on the tax roll or latest deed) Iftml~icant is it~orporation, signatu~'~xof duly authorized officer. ........... (Name'find title of corporate officer) Builder's License No .......................... PlumbeF's l.icense No ......................... Electrician's License No ....................... APPP, OYED AS NOTED DATE:/'*//I~q- B.P. ~ FEE:_L- '_-'_ .... BY: _b NOTIFY BUILDING DEPARTMENT AT 765-]802 9 AM TO 4 PM FOR THE FOLI OWING INSPECTIONS: ,L FOUN~nATION - TWO REQUIRED FOR P~URED CONCRETE 2. ROUGH - FRAMING & PLUMBING Other Trade's License No 1. Location of land on which proposed work will be dou~$5",4:~.*ClO~[. ~HA~_.L..~.E~.~...$...kC. ~.:.. .~... e~ .................... S.T.&T[. CDi'-JSTEUC.T. ION. &..[N.FPG¥ ............ House Number Street CODES. NO'IHa~h[8PONSIB LE FOR DESIGN OR fONSTRUCTION ERRORS. ,, 4ff County Tax Map No. 1000 Section [ O [ 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 .......................................... b. Intended use and occupancy t 1~ v . .~:., ~ .,~ ..~.: ;~:~,.. ,,..~ ,.~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .... e-,t .,. Repair .............. RemOval .............. Demolition .............. Other Work ~.v. ~ ? ~O.d~. ~. ! · (Description) 4 F t' atedCost ' Fee (to be paid on filing this application) 5. If dwelling, number of dwelling?nits ............... Number of dwelling units on each floor ................ If garage, number of cars .... , ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. l)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... !?.eight ......... iiii .'~ NPc~lmber of Stories ..... i ~. ~11 9. S~ze of lot: Front . ; ........... Rear .................. Depth ... ~ .~t~ .............. 10 ~at of Purchase ' Name of Form r Owne 1 I. Zone or use district in which pr~mises are situated ..... 1~ ."..[ ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... . .~..0 ........................ 13. Will lot be regraded ..... ~' i .......... ~ ....... Will excess fill be removed irom premise, s: Yes Name of Architect ..................... Address .~ .... ~'~ '~' .... ~ i~!1 ~ .~ ~ .... Address ~<1 ~ ..... 't ......... Phone No.~ Name of Contractor Iq. ~ ' ' ' ........... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to ~leed, and show street names and indicate whether interior or Corner lot. STATE OF N~ Y~K,. t i. ~ ' .}..~. ~.~. ~.~.~.~ ~. ~ ..... : ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~mg contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file ~s application; that all statements con}ained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfomed in the m~ner set forth in the application filed therewith· Sworn to before me this ta. Public .......... ~... ~ ( ~.~; (Signature 'of applic~t) T~