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Home My WebLink About13269-zTOWN OF SOUTHOLD BUILDING DEPAkTM~NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13269 Z Permission is hereby granted to: ..... '( JO?~ L, ~ ,o I ~<~ ' ... at premises located at ......~...(-R. ......... .~... ......... !.~j.~.....(~:~l. .......... ~V...~..~.........%~. ...................... County Tax Map No. 1000 Section ...... ..~]....~. ........ Block ....... ~.'~ .......... Lot No ........~.. ............... pursuant to application dated .... ~..~.-~.....~i~1.~. ..................... 19.9...~J.., Building Inspector. and approved by the Building Insl~ctor Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 Approved ...~. I .(-e. .... 19~. Il. Permit No.]. .~. ~ ~..Cl..~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... INSTRUCTIONS a. This 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 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 perm. it shall be kept on the premises available for inspection throughout the work. e. N~ bui~ding shail be ~~cupied ~r used in wh~le ~r in part f~r any purp~se whatever until a Certi~eate ~f ~~cupan~y 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. .... . .77.e.,~.~.~.,(. ~.../Z.¢.~.~.~. ~ ~5...U..~..~.'.//c./.~ ~ (Signature of applicant, or name, if a corporation) ...?~.~.~...<?.e....~..q~..¢.,.~..,./c.../.< ~. ././. .q.. .<~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ (7? ~r~ .~. ~:?.. ~... :../.-~..<q3. < ................................................... Nmne of owner of premises .ffff .ff.J...~ 5!...~.: .~.c./~ ..... .~.'.~../.T?? ..................... . ................ (as on the tax roll or latest deed) If appl~ca~t ' a corporati~nature of duly authorized officer. ..... ...... t~ 'f - i~'a~e and title of corporate officer) Builder's License No ................ .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No .......... :-. .......... 1. Location of land on which proposed work will be done .................................................. ...... .4¢...~.:*. ........... ~.,:~..Z.~.. House Number Street Hamlet County Tax Map No. 1000 Section ...O.7,..~.,.O.Q ....... Block .. O..~. '..O..0 ........ Lot...~..O...~: .O..O..(D. .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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;...'?¢ j..~. ~: t. ~ ................... 3. Nature of work (check which applicable): New Building .......... 'Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work t'..~'fT.~.. ~.-f ....... ~ (DeScription) 4. Estimated Cost ........... , ...................... Fee .................................... *" (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................... ,. .............................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structurgs,if any: Front ............... Rear .............. Depth ............. Height ............... Nun~ber 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 ............. Height ............... Number of Stories ........................................................ Size of lot: Front . .c~.O...~..e.r.~.~. ......... Rear ...................... Depth ...................... Date of Purchase .......... i .................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lo~ be regraded ........ ; ................... Will excess fill be removed from premises: Yes No Name of Owner of premises .~.,t l.,.~tn.. ~..~.~. ~. '.~. .... Address .~?~.~..r'?. q,..a. ,r.~: ..... Phone No. 7~ .~f. ~ ~-[.~ t 7 Name of Architect ......... Name of Contractor ........ i ................. Address ................... Phone No ................ 10. 11. 12. 13. 14. property lines. Give street and blocklnumber or description according interior or corner lot. PLOT DIAGRAM Locate cleariy and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from to deed, and show street names and indicate whether /I AppROVI~D AS NOTED F~D. /~ ....... ' NO~ BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR TH~ FOLLOWING INSPECTIONS: ~, FouNDATtON- TWO REQ FOR pOuRED CONCRETE 2, AOUG~ - FRAMING & PLUMBING 4,F~NAL - CON'STRUCTION MUST ~ C~F~?I ~wF FOR C.O. .STATE OF NEW YO. RK~,~, .~Z'. . S S COUNTY OF ............'mc:2~7'/~2~t'~'~c'-~ i ' .... ~../.A./..~O..~...~.f.. _ .~..~.=.,~..~.cd..~../.o ..............being duly sworn, deposes and says that he is the applicant (Name of individual signling contract) above named. He'is lhe ~ (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this . i Notl; Publlo, State of N~w yom 4-/ ~ - --~ '~, ' ~mml.~lon Explre. Mama 30, ~eO~' .... (Signature of applicant)