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Home My WebLink About12931-z FORM NO. ~ TOV~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CCg~APLETION OF THE WORK AUTHORIZED) 12931 Z premises IOCoTeo aT .................................. , ............... , ......................... ; .................. County Tax Mop No. 1000 Section ..... .~....~.....~.. ..... Block "~)-' Lot No. I ~ pursuant to application dated ....... ..~.~....!..~.. ................ , 19.~...1..., and approved by the Building Inspector. Fee $...~... J..~ ....... Building InSPector Rev. 6/30/80 :xamined . ) .ox.'~..c% 3. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 .., 19~.t J .., 19. J. Permit No../..'./, Received ........... ,19 )isapprovcd 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 :is of plans, accurate plot plau 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 ~ areas, and giving a detaled description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered ~y this application may not ba commenced ~efore issuanc~ of Building Permil. d. Upon approval of this application, the Building lnspocto~ will issued a Building Permit to tho applicant. Such pe~nit hall 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 auy purpose whatever until a Certificate of Occup~cy hall have been granted by the Btfihling Inspector. APPLICATION IS tlEREBY MADE to the Building Dep~tment for the issuance of a Bnilding Permit pursuant to the luilding Zone Ordinance of the 'Ibwn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~egulations, for the construction of bu~d~gs, additions or ~terations, or for removM or demolition, as herein described. he applicant agrees to comply with all appHcable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectom on premises and i9 building for necessaw in~ections. ,./ l.~ckDiz~)~Adg~, (Siguature of applicant, or name, if a corporation) (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrieian, plumber or builder. A .q- ........................................... ; ........... ';' ' ~ ~. c ~ ., , -~ ....... D AS NO~BD %me ol owner of premmes .. ~C2~.2.C-t :~.. J J.Cff. [YI9 ................. ~)~X' ' k'X ' ',: '~ '~9' ~ ...... (~s on the tax roll ~llI~~.r' ~ f applica,t is a corporation, signature of dnly authorized officer, FE.~E' ~- ............. ~ B . NOT~FY BUIuDING DEPARTMENT AT 765-1802 ~9 AM TO 4 PM FOR (Name and title of colporate officer) FOLLOWING iNSpECTIONS: l. FOUN~p'qION ' TWO REQUIRED Builder's License No .......................... FOR D~t}Rc[3 CONCRETE 2. ROUGH - ERAMING & pLuMBING Plumber's License No ......................... 3. IN%1! A" 4. FINo~ CC>N.ST~U¢' NQN MUST FOR C. O. klcctl~c ,ms License No .... ¢~ r' "~ol VTF ALL Cok'cmq'~CT}ON SHALl,. MEET OF THc N. Y, Other I adc s Llttnse No. THE RFo~ STATE CONqTRUCTION & FN'~qGV . L cab . t t . . , y DESIGN OR CONST~UCTIOm o .......... *-/'qo -45 ... 7 fq.a .......... ................................. llousc Number Str~ct Hamlet County Tax Map No. IOOO Section .OTJ 5'~.~ ........ Block ....... ~ ....... Lot ..... []~, ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~. State ¢xisljng use and occupancy of premises and intended usc and occupancy of proposed construction: a E×istin- use and occupancy · occu,,ancy b. Intended use and 3. 1. 2. 4. Nature of work (check ' ' ' . ....... which apphcable) New Building . . Addition .. Repair .............. F, emo mi .............. Demolition ........... Estimated Cost ................................... Fee . .' .... ....... Alteration .......... .. Other Work (Description) (to be paid on filing this application) If dwelling, number of dwellin Units ............... Number of dwelling units on each floor ................ Ifg ara,eg, number of cars ..... , ............................................................ ,, 'c~., .c,'~" t./.,~. If business, commercial or mixed occupancy, specify nature and extent of each type of use Din, ensions of existing structure~, if any: Front ............... Rear .............. Depth ............... lieight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i.. Height ...................... Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nmnber of Stories ........................................................ Size of lot: Front ...........i ........... Rear ...................... Depth ...................... Date of Purchase ........... i .................. Name of Former Owner ............................. Zone or use district iii which preinises are situated ..................................................... Does proposed construction violMe any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes Nc Name of Owner of premises . . .I ................. Address ................... Phone No ................ Nan, e of Architect .. '. ....... l ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all,i buildh,gs, whether existing or proposed, and. indicate all set-back dimensions from roperty lines, Give street and block gumber or description according to deed, and show street names and indicate whether nterior or corner lot. TATE OF NEW YORK, ,S.S 'OU TV OF. ................ : (Name of individual signing contract) bore named. (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly attthorized to perform or have performed the said work and to make and file this pplication; that all statements conthined ~ this application are true to the best of his knowledge and belief; and that the /ork will be perflmned in the mann6r set forth in the applieltion filed therewith. worn to before me this Iotary Public, . ...................... ~h3~&~*[ PUOHG. $h~te of New ~mk (Si~ature of applicant)