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Home My WebLink About13278-z ~'ORM NO, ~ TOWN O~ 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) N? 13278 Z Permission is hereby granted to: .................................................... . ................. at premises located at ..!..~ ........ ~ ..... : ...... County Tax Map No. 1000 Section ..... ..c~....J...~. ........ Block ........ ..~ ........... Lot No. ~ '~ Building Inspector. and approved by the Building Inspector Rev. 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ., 19~' ~'. Permit No. ).'.~..D.~.~..~ .~-'.. Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ~19.. · a. This application must be completely filled hi 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· -- . --_ .'.~.~..~.~ .~. (~.... ~i ./~..~...~. ~. ~, .~...~.c~. (Signature of applicant, or name, if a,~rporation) -- --- ' ....... State whether applicant is owner, lessee, agent, architect, engineer,' ' egen ral c'(~ntractor, el- - ectriciafi, plumber or builder· ........ .C2. ~. ~. ~ ..F. .......................................... :....: ............................ mame of owner of premises ~..~'.~.~.~.~ ./.~. · ~.././/~....~.~.. '-~' "~''~"/' "''~'''~"''~'~ ........................ (as on the tax roll or latest deed) If applican~is a corp, oration, sign._a,ture of duly author'ce~ officer· (Name/and title of corporate officer) Builder's License No.~.~ ....................... Plumber's License No....~..... Electrician's License No...~ ....... Other Trade s L~cense No./. ................... ~ ~ · . I. Location of land on which proposed workwill be d°ne ~>~ // t~;&~e' ~ ..................... ~ir~i ....................... ~t~n'l;~ ........................ County TaxMap~. -..~. ............ B~... Lot ................... Subdivision~d aM pNo .... i ......... Lot ............... State e~duse an~~roposed construction: 10. 11. 12. 13. 14. N k( h ppli ) N"~I"~ ¢~ ature of wor check whic a cable: e,, ~-~,,s .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (]-~_' ~.~3 ~..~...t~...~.. /.~.-, ~ (Description) Estimated Cost. . ~ .. .' ......... Fee . .-. (to be paid on filing this application) If dwelling, number of dwelling ~nits ............... 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 ..................... Dwnensmns of existing structures, ~f any: Front ............... Rear ........ ~-~/)~pth ............... Height' .~. ( ........... Nunlber of S~V... '--'-~5~--,~ ................................... Dimensions of same structure w~th alteratio~i~'~'~-~ions: Front ................. Rear .................. Depth .................... ~.. Height ...................... Number of Stories .................. Dimensions of entire new construction: Front ............... Rear ............... Depth Height ............... Number of Stories ........................................................ Size of lot: Front .......... ; ........... Rear ...................... Depth ...................... Date of Purchase .......... : .................. Name of Former Owner ............................. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ ~ ..... . .............. Will excess fill be removed from premises: Yes No Name of Owner of premises ..: ................. Address ................... Phone No ................ Name of Architect ......... : ................. Address ................... Phone No ................ Name of Contractor ........................ Address ................... Phone No PLOT DIAGRAM Locate ¢le02'ly &nd distinctly ail! buildings, whether existing or proposed, Rnd, indicate all set-back dimensions from property lines. Give street and blockinum~b~r__or.~es_~p~[o~n_gc¢ordin~.t_o_d~e~, ~a~d sho~w streetnames and indicate whether interior or corner lot. DATE' I~ ' ' I cr~ECTIONS: ou-°W, ' TWO 1, FOON~A/IUI''I - R poURFD cONCRETE FO - " pLO ROUGH -- FRAMING & : ~ 2. ALL CONRTRlJC'~)tN ' - ' ~E, REO~H~kAFN~% OF T}-~ STATE CONSTRUCTION g' [ CODES. NOT RESPONF'BL¢ FBA DESIGN OR CoNSTR~CTIO~I ER2ORS. STATE OF NEW YORK, S.S COUNTY OF ................. .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sign'ing 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 conthined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this i ............... ?..~.. .... dayoi .... .~ ........ ' .... 19 .~'..~ Nora .ry Public,. ...... ~..~.~, ~. ~ f ,~.%~,-,. County // '~ No, 47Q7878, Suffolk Oount~ .... Term Expires M,arch 30, 19~S