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Home My WebLink About12963-z FOBM NO. 2 TO~N O~ $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12963 Z Permission is hereby granted to: ........ ..................... ./....C~..J.~.......~...~ ..................................... _ . .............. .~......~....~. ........ ;.~ .................. ~... ,o..~.....~~...~....~...~.~.~...~.~ ...... ~.....~.~..~. et premises located of ....~i;[[~...."~"~.~...~.~....[~ ........ ~..~..~~ ................. County Tax Map No. 1000 Section ...j....O....~ ........... Block ....... ..(~).! ....... Lot No..~?....~..?...~..,..~.."]- pursuant to appJication doted ..... ..~..~...~ ...................... , 19..~(...., ond opproved by the Building Inspector. Fee $...). ................... Building Inspector Rev. 6/30/80 OR'EDGED '. ,~ NANCY GR, dH~M INLET 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..'J.~.OM-..~...~q...., 19 Approved ...~ .~.. :~.x....~c..., 19 ~J .~. Permit No./. ~.~.} .G. ~..~__.. Disapproved a/c ..................................... (BuiIding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date.. J/,~: ......... 19~,?. a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~eg$ions. (Signature of applicant, or name, if a corporation) d. . .c. < . .,ddk'. .. . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... a4. fl .................................................................. Name of owner of premises t/~.~Z'.e'.~ .~ q...(.: ./,~..~.,Y... AP;': .... ~ ~,$ NOTEI} .................. · ........ ;/ .............. (as on the tax roll or la~e~l) · . _ ._ - If applicant is a corporation, signature of duly authorized officer. FEE: .............BY: NOTIFY BUILDING D~PARTMEN~Z A-i: 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS: l. FOUNr)ATION _ TWO REQUIRED Builder's License No .... ..~..¢.,~..F. ............... FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION Plumber's License No ......................... 4. FINAL CONSTRUCTION MUST BE C'M4PI FTE FOR C.O. Electrician's LicenseNo ....................... ALL CONCTR~JCTiON SHALL MEET Other~rade's License No ...................... THE RFC~ II~MENTS OF THE N.Y. STATF CONqTRUCTION & ENERGY 1. Location of land which proposed work will be done. ~.t~ ,- z, COrj~q~,,~,.N,3T RESPONSIBLE FO on ......... rt ' ' ' Y. Od. Q ........ ./z. .z,. ...................... .C 7.'.2 ./z ,,X'.,,. ¢ ................................ House Number Street Hamlet County Tax Map No. 1000 Section .... [~. ~ ......... Block ...(~7..ff. ........... Lot .~.A. .~..~.4: ??..~. .... 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 .X~¢.Y./.~.q~..~/'. .......... ff..t~s/~,..~ ~]A~.../~..~.4'.~.~ ....................... 3. Nature of work (check which applicable): New Building ..... ' .....'Addition ...... ~ation~ .......... Repair .............. Removal ............. Demolition ............ ~ .,~-:~A~ ~. ..... i (Description) 4. Estimated Cost ............ i .......................... Fee ............................. ... ~ *" (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars .... ! .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extant of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories.. ...................................... ................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ]... Height ........... Number of Stories ...................... 8. Dimensi]ns of entire~ new construction: Front .......... .Rear ............... Depth ~ / ~. '. . 10. Date of Purchase .. ~'/~IF/.7.~...,~/.. ~ ........ Name of Former Owner ~.t.$¢~...~.~'~. t~.AJ.q. .......... 11. Zone or use district in which premises am situated ..................................................... 12. Does proposed construction vidlate 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 .. i .................. Address ................... Phone No ................ Name of Architect ......... i .................. Address ................... Phone No ................ Name of Contractor ........ '. ................. Address ................... Phone No ................ Locate clea~~ther existi_ng~o_r proposed, and, indicate all set-back dimensions from property lines~ block number or desc~ipti0h' a~¢~rdih~g to d~d;-~hffd s~h-o~v'street names and indicate whether ~ntenor or cc ~er lo~..x. ~ .__.. FIELEN K DE VOE ~ NOTARY PUBLIC, State of New YorJ~ No, 4707878, SufteH( CmmW Term E',olrc..~ March 30, 19~t~5~ .. County .............. (Signature of applicant) STATE OF NE'W YORK, COUNTY OF ................. ................................................. being duly sworn, deposes and says that 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 dul~ 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 manner set forth in the application filed therewith. Sworn to before me this '~3q../~. · .... day of'. ,,.~. 19~