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Home My WebLink About12976-z FORM NO. Il TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~MPLb-'T'ION OF THE WORK AUTHORIZED) 12976 Z Permission is hereby granted(~4~ ,~ r -- ~ ~, .... ..~m~.~...~..:..~..:....!..!..~..~.~. ...... ~ LL~~..or ~..~~ . ~ ................... ~ ............. at premises I~ated at ....~...~.~ ....... ~.~ .................. ~ ................... / County Tax Map No, 1000 Section I 0 )-- Block 0 ~ Lot No ..... ,.~,..,D_.,~. ...... pursuant to application dated ...... ...~.~[~..~.......~....~. .............. , 19~...~..'o, and approved by the Building Inspector. Fee ,..L;~.~.~ .... Rev. 6/30/80 ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ..~.~!~../.~ ..... , 19 ~}t. Approved . ~...q .... 19~ ~. Permit No..J .~..~.-1..(o. 5. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 gNing 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. , · 4.,.: ..... ....... (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. ....................................................... AW::.,SV:5 '. ig ....... Name of owner of premises . .~7~.. ''. ........ ; D)~TE;t4[~ '~" B'P'~ ']' .Dc~.~.:~- - · las on the tax roll or latesrou~i ' ' . FEE:_~__,_ "-'"' _BY: {,,,). ~, ~-, . If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ~.....~. FO~ POURED CONCRETE Builder's License No...,_5'.~.~ ' .............. 2. ROUGH - FRAMING & PLUMBIN~ 3. INSULATION Plumber's License No ......................... 4. ~INAL - CON'STRUCTION MUS~ BE C'%MpLr:TE FOR C. O. Electrician's License No ....................... ALL CONSTRUCTION SHALL MI:~T THE REOL/IREMENTS OF THE N, Y, Other~rade's License No ...................... STATE CONSTRUCTION & ENERGY ·rf~./ C-~DE..~CZ'-',-BIOT ~R_E.S.?~.NSIBLE FOR 1. Location of land on which proposed work will be done..~. ~..':~...'. ~.a~8~TIONt ERROR$~.. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.()..c? ........ Block 0 'b Lot 0 '"' % ...................... ,.~.~ C~ ........... Subdivision ....... /~. ...................... * ...... Filed Map No. .~.. .......... Lot .... .~. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3 Nature of work (check which applicable): New Building ' 'Addition Alteration : Repair .............. Rempval .............. Demolition .............. Other Wor~~.~ ~ (Description'J 4. Estimated Cost ...... i ................... 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 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 ............... Height ............... Number of Stories.. ....................................................... Dimensions of same strncture with alterations or additions: Front ................. Rear .................. Depth ............... i. Height ....... ~. ~.../ ........ Number of Stories ............... 8. Dimensions of entire new construction: font . .~. ,4~-'/'/'/'/".~. ~.~ar .~']~..~.)~. ... Depth ,Zd~.a .,.~... ~ Itelght ............... -Num.~ .61~-~ . .~.c/~¢,..~'~: .-~:.~:¢.~0~.~q .................................... 9. Size of lot: Front .. ,/./..,*. ~ ........ Re]{. g//:J..~....~ ....... Depth . .~l ,~-d. t.".~ ....... 10. Date of Purchase .......... i .................. Name bfFormer Owner ................ ~ ............ 1 1. Zone or use district in which pr~mises are situated .................................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ................. Address ................... Phone No ................ Name of Architect ........................ Address ................... Phone No ................ Name of Contractor ........ ~ ............... Address ................... Phone No ................ PLOT DIAGRAIVl Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S · COUNTY OF ................. '~'(Name of individual signmg contract) above named. being duly sworn, deposes and says that he is the applicant Heis the ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully 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 manne'r set forth in the application filed therewith. Sworn to before me this i .......... ....... day .......... HEL£N K DE VOC' "~' ~"]OTARY PIJBI J{~, Slate of New York ... County ............ (Signature of applicant)