The URL can be used to link to this page

Home My WebLink About13275-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ C~, (~ ~ c.,. · . ~o ~ .... .:. ........... :..~..~m ....... ~...~.....~.~......~ ..................... at premises located at ...~...-]...~...o. ........................ Count~ Ta× Map No. 7000 Section ...... ~...~.~ ..... mock ......... ~ ........ Lot No ........ ~...~,. .......... pursuant to application dated ..... '' ".~...~. ............................ , 19.~..~...,-' and approved by the Building Inspector. Re~ 6130/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~..}.[~...,19 Approved [.~. ....19~. ?. Permit No./. ~.~r. ·~. .~'...5~ Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... 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 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 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. . ................. .F~,ignature of applicant, or name, if a corporation) .z/so. ..... .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~)~ ///'c0~!/.~. $..~. ~.'~. ~.../Tr~.r. ~'./'~ ..... /.?~ F.~. ............................ (as on the fax roll or latest deed) If appli .scant is a corporatign, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...O?.. ~ ................. ~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which pro. Dosed ~ork will be done .................................................. .... ........................ .......................... House Num bet Street Hamlet County Tax Map No. 1000 Section ...0.~.. .......... Block .... .O..~. .......... Lot .... ~ ./.~. .......... 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 /c ~ A/( z' b. Intended use and occupancy ................................. . ................................. 10. 11. 12. 13. 14. Locate clearly and distinctly all property lines. Give street and block interior or corner lot. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work. ~...~: .~(.e~ ...... ~, (Descriptio) Estimated Cost c~ {~, ~3 Fee ~/ ~ '- (to be paid on filing this application) If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................... : ............. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ..... if any: Front Rear Depth D~ens~ons of ex~stlng stmcture~ ............................................ Height ............... Number of Stories ....................................................... D~ensions of same structure with alterations or additions: Front ................. Rear ................. Depth ~ HeiSt Number of Sto~es D~ensions of entire new construction: Front ............... Rear ............... Depth .............. Height Number of Stones'. ............................... Size of lot: Front ................ Rear .................. D~pth .. ................ Date of Purchase ~ Name of Fo~er Owner Zone or use district in which pr{mises are situated ..................................................... Does proposed construction viol'ate any zoning law, ordinance or re~lation: ................................ Will lot be regraded ........................... Will excess fill be removed from premises: Yes No N~e of Owner of premises ~4~ q~..~d.q~ ....... Address ~ t ~. ~z~t~ .~ ~ ~ Phone No. ~.~ C: .~ 2J'~O... N~e of Architect Address ~ o~t~ ...... ~(~. 72~- .............................................. Phone No ..... Nme of Contractor .......................... Address ................... Phone No ................ P~T DIAG~ burdens, wheffier existing or proposed, ~d, indicate ~1 set-back d~ensions from tumber or description according to deed, ~d show street names and indicate whether APTYZ2'..~ AS NOTED ..... -~ .........................................NOTIFY BUILDING DEPARTMENT AT % '~ 765-1802 ,9 AM TO 4 PM FOR THE ~ , ~ ~ FOLLOWING INSPECTIONS: FOR P~UR~D CONCRETE ~ ~ 2, ROUGH - FRAMING & PLUMBING / ~ ~ 4. FINAl- CqN'Sm~I~CTION MUST L ,~ I . ALL CONSTRtiCT~QN ~NAL,L MEFT ' ~ ~ THE REQ[JIRFMEF~TS ~F THc N, Y. ' STATE CONSTRUCTION & FNFPGx'~ NOT RESPO~IS[~ ~: r:orL CODES. DESIGN OR CONSTRUCTION STATE OF NEW YORK, COUNTY .... ,js's .~ //V'~..// /zU /v~z.~, C ~( ~ / o being duly sworn, deposes and says tMt he is the applicant (Name of individual signing contract) above named. He is the (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 cont~dned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne, r set forth in the application filed therewith. Sworn to before me this Notar~ Publlo, ~t~te of New York .{..~..,~z<~, .-v~. -.' ............ NO, ~2..0~141~ Suffolk Oou~/rTlc'''~ -- ! (Signature of applicant)