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Home My WebLink About12967-z FOF,~ NO. ~ TOWN OF $OUTHOLD 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? 12967 Z Permission is hereby granted to: O /~ .............. ..... ,o. ....JT......~..?. ............................... ~......~,.~... .................. County Tax Map No. 1000 Sect,on ~. Block . .. t N . pursuant to application dated .... ...~.~..~ .......................................... , 19.~..~.., and approved by the Building Inspector. ,~,/ Fee $.....~ ..... Building Inspector Rev. 6/30/80 ~ 19gq Examined ... :~.C~C~ .~0.., ... \ Approved ....~..O.&...~. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 13971 TEL.: 7654803 ., 19~.~. Permit No. ).~..C~ .~.'?.~; Disapproved a/c ..................................... · L).: ..... (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 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 regulation_s, and to admit authorized inspectors on premises and in building for nec.~essa~aain~pections. (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. 7 .......... ~..J..~..~../.~.< .~..~. ...................................................................... Name of owner of prem scs ~' .......................................... ~,'-'~ ~' 4,.' ..................... (as on the tax roll or late~4~'~ ,~D AS If applicant is a corporation, signature of duly authorized officer. ....... ............. (Name and title of corporate officer) Builder's License No ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... NOTIFY ~0-1LDING DEPARTMENT AT: 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION _ TWO REQUII~ED FOR POUR[D CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. EINAL - CON'STRUCTION MUST BE COMPIZTE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMEN - TS OF THE N.Y. 1. Location of land on which proposed,)/vork will be done ........ ; .... .S.TATE. CONSTR 'tOOT. ION · &. TNERG? ...... "' ~ s //~ &./ CO, DES/ NOT/,/~i~I::X~NSiBLE F o. . : ?.,. . . , . . 6. . . ./. . . [ louse Num bet Street Hamlet / County TaxMapNo. 1000Section ........ O./ ....... Block ....... ,~ ........ Lot .... ~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~s¢'A,"f ~(.~ ........... a. Existing use and occupancy ............................... ~..." b. Intended use and occupancy .. ...... ?.-~ ..... ~,~...,s.. ,.:, ...... . ............. 3. Nature of work (check whtch a~phcable): New Building .......... Additlon .......... Alteratm,~n .., ....... Repair .............. Remloval .............. Demolition .............. Other Work .~.-..~,27...</:?,,~ .... ~//~?. ~-~ ./~ (Description) 4. Estimated Cost Fee (to be paid on filing this application) 5. If dwelling, number of dwelling! units ............... Number of dwelling units on each floor. If garage, number of cars .... .................................................................... 6. If business, commercml or m~xed 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 structure with alterations or additions: Front ................. Rear .................. Depth i Height Number of Stories 8. Dimensions of entire new construction: Front .......... .. ..... Rear ............... Depth ............... Height Number of Stories 9. Size of lot: Front ....... ~ .~ ./ .......... Rear .... ,~ g) r Depth ./..:~.q .r.... 10. Date of Purchase ..... ' ......... Name of Former Owner ............................. 11. Zone or use district in which pr:emises are situated ..................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation: .......................... 13. Will lot be regraded ........ ................... Will excess fill b~ remj~ved from premises: Yes No 14. Name of Owner of premises .~.t.~.~. 9. ' .~.~.'~/' .~.' ~.fi.. Address .~.~.~.o¥~,../~.~...o? .~rf.~.?. Phone No..'.?.~. ~7.2'.°! .o.... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block, number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF.NEW~ORK, . . COUNTY OF..~. .......... '~..' .~.ff?. · · ~;..~C.~q~.q/? ............... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. I' ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application f that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ndr set forth in the application filed therewith. Sworn to before me this~ ......... . .~..'~:..day o; ..... Nota~ Pu bli~Z~~~~ounty ~D~H X. TE~y ~ ~re8 M~h ~, 1~ (Signature of applicant)