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Home My WebLink About13234-z F~'uM* NO. fJ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJV~PLETION OF THE WORK AUTHORIZED) N? 13234 Z Permission is hereby granted to: ...... c~t premises Iocoted et ....... ,?,..~..,.',~ ....... .,.~, ~....~,,,.; ............ ,~~ ............................. County Tax Map No. 1000 Section ...... .,0..~. ,0. ....... Block ...... ...-7. ........... Lot No ........ !. ............... Building Inspector. and approved by the Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Approved ~-~-t ~ .~ ., 19~.t. PermitNo..L~..a...~..~.'.-~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. Date ................... 19... ~ INSTRUCTIONS a. This application must be 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 Occupahcy 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. , ..... y.,.%9.. ...... (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. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. '~" (Name and title ;~ co~orate officer) DATE. {,I/~[?~B'P' '~ Builder's License No .......................... F~e:~.~n D[p~K/t NOTIFY BUU_uu~ PM FOR Plumber's License No ......................... 765-~802 9 AM TO 4 FOLLOWING INsP[C~ IoNS:REQU~RED .... o ~. FouNr~ATiON - TWO Electrician s L~cense N ....................... FOR D()tJRg. D coNCRETe Other Trade's License No ........... : .......... 2, ROUGH - FRAMING 8, pLUbABING 3, NSUt-A, ~ Cn~,,c~RUC, ~ION ~.usT 1. Location of land on which proposed work will be done ............ &. F}~{~;k<i,m ~. F~R. E. n .... ::~ ....... Cohnty Tax Map No. 1000 Section ..... ........ Block .... ~. Subdivision ..................................... Filed Map No ............... Lot ..... :'. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing use and occupancy ................................................................ b. Intended use and occupancy .................................................................... Nature which New Building Addition .......... Alteratio.n ,. ......... of work (check Other Work.. 2. i.~. ...... Repair .............. Removal .............. Demolition . · q~ .......... ' -' (Description) Estima Cost .... ~ ...................... o e on filing this application) . (t b paid 5. If dwelling, number of dv~elling finits ............... 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. Dimensions of existing structureS, if any: Front ............... Rear .............. Depth .............. I of Stories ' Height ............... Number, ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... !.. He~.~ .. ........ Number of Stories ..................... Dimensions of entire new construction. Front .... ~. ~'. ..... Rear .. ~.. ~.. ....... Depth . .~.'./ ....... /.~. ~ Number of Stories Height' · ......................... 9 Size of lot: Front Rear Depth .............. Name of Contractor .. ?c.T*.q · ~.of..~ .t~. ........... Address ~(b.~.*..m..~¢...~ (/,.ge ia0. Phone No.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. 1' STATE OF NEW YORK, ! S.S COUNTY OF ' ' applicant ' being duly sworn deposes and says that he is the (Name of individual sig'ning contract) above named. He is the ~ ................ i (Contractor, agent, corporate officer, etc.) -o~,~aid owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this appii'da.tion; that all statements contained in this application are ~ue to the best of his knowledge and belief; and that the work w~l ~e perfomed in the m~fier set for~ ~ the application filed therewith. Sworn to ~efore me this ........ ' ..... ~.~ ...day ~f...~ ........... ,19~ ' ~t~ Public, ' ..... ~. Z. ~*.~. County ................ lerm Expire. l~..rch ~O,