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Home My WebLink About13252-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y, BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13252 Z Date ........................ Permission is hereby granted to: , ^ ~'~ .... ................. ..... .~.. ~ ...... ~ ........ :~., ........ ~..' ................. ...[~,~.~.~,~ ....... ~:~;.~.~......~..~.;......~,~ ..... ~.~.......~..~ ;~.~....~_ ~t pr~mises I~ated at ....... ~ ................ ¢* .............. Coun~ Tax Map No. 1000 Section ..... .~..?.;i.~ ......... Block ..... .-). .............. Lot No...~...'.~. .............. pursuant to application dated ..i/;~.,'~ ........ .~. ........................ , Building Inspector. and approved by the Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN HALL ~ ... 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 xamined. ,~.c~,,c4,...~>~ .... , 19~.\~.. ,pproved . ~.. ~..% . ·., 19~' .~. Permit No ) ~:1._ ..... }isapproved a/c .............. i ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ts 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 c areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. c. The work covered by this application may not be com~nenced before issuance of Building Permit. d. Upon approval of this application, the Building'Inspector will issued a Building Permit to the applicant. Such permit roll 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. ;all have been granted by the Building Inspector. APPLICATION IS ItEREBY MADE to the Building Departmbnt for the issuance of a Building Permit pursuhnt to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and hi buildhig for necessandlh'0e~tio~s. · (Sign~ute of applicant, or name, if a corporation) ~ - (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluraber or builder. lame of owner of premises -F, Z~ + ',~I. ...... "' .......................... ............ (as on the tax r est deed) ' " applicant is a gorporation, signature of duly authorized officer. (Name and title of corporate officer) Bt ilder' Lic No ~ i s ense .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.. ! ................... APPROVED AS NOTED ATE: q4 ¢ NOTIFY BUILDING DEPARTMENT AT 765~1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - ~O' REQUIRED 'FOR POURED CDNCRETE 2. ROUG~H - FRAMING & PLUMBING. 3. INSULAZION 4. FINAL - CON'STRUCTION MUST Location of land on which proposed work will be done.. ~ ..... BE C~MPLETE FOR C.O. · ' ' ALL' 'CONST'R'UCT~'ON' 'SHALL' MEET ...... ..... /'"~: ..... ' ....i ........... Street ~ STAYE' 'Cr~OoN_,~F~,R¥CTIOiXI'" &' 'ENERGY' [louse Number coDEs,.' '"YqtYl* RESPONSIBLE FOP. DE,S,q~. N. OR CONSTRUCTIO~t.L~RORS. County Tax Map No. 1000 Section . ..:/..?. ~ ....... Block, .... ............. Lot ................... Subdivision .......... . ........................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occpp~ncy of proposed constrnction: a. Existing use and occupancy ........................................... b. Intended use and occupancy .......... /.~ ................................................. 3. Nature of work (check whlch apphcable): New Building .......... Addition .......... Alteration .......... Repair .... .......... Removal ........... ... Demolition ..... ....... .. Other Work .. .~.Z'dd~..~ 4. Estimated Cost ................... .~.. Fee ...................................... ~ *" (to be paid on tiling this application) 5. If dwelling, number of dwallingI nnits ~ ...... Nmnber of dwelling nnits on each floor ....... If garage, number of ,cars . .~. i ...... '" ................................................. ' .... 6. If business, commercml or m!xed o ce~u~ancy, specify nature and extent of eacli type of use .......... ~.. 7 ..... Front Rear Depth · D,mensmns of ex~stmg structures, ff any ................................... Iteiglit Number of Stories' Dnnens~ons of same structuro With alterations or additions: Front ................. Rear ................ .8.~enth . ;. Hei t ........... ,- ............ ,.. . gh ........... Number of Stories .................... tmens~ons, of enhL~g.9..olmttaotio~: Front ............... Rear ............... Depth ........ lteight . ~./. Number of Stories. 9 Size of lot: Front ....... .. i .. Rea: .................. Depth ........ 0. Date of Purchase ........ !. i .................. Name of Former Owner ............................. .1. Zone or use district in whlchlprennses are muated. .................................................... 2. Does proposed construction ¥iolate any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded ...... ~ .................... Will excess fill be removed from premises: Yes No 4. Name of Owner of premises ! · · · ... Address . Phone No. Name of Architect ........................ Address ................... Phone No ................ Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly all: buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether aterior or corner lot. rATE OF NEW ~RK// / (Name of individual sign ng contract) ~oYe llauled. e is the ...................... .. (Contractor, agent, corporate officer, etc.) · said owner or owners, and is duly anthorized to perform or have performed the said work and to make and file this ~plicafion;. that all statements, cofitained, , in this application are true to the best of his knowledge and belief; attd that the ork will beperformed m the man,er set forth in the application filed therewith. vorn lo before me this I ...........~ ~..~. .... day eel... ...... ,19 ~. ~ NOIARY PUBLIC, State o{ New York ! ' ' (Si~ature of applic~t) No, 4707878, 5oilolk GoaOtM lerm Expires March 30, 19~