HomeMy WebLinkAbout13323-zTOWN OF 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? 13323 Z
Permission is hereby granted to:
.... ~.~.....~..:....L~.~ ....
...~..~ ...... ~~.~ ...... ~ .......................
~.~...:~.,..v.,.'...u....'t..~J. ........ ,-~
at premises located =t ............................................................................................................................
County Tax Map No. 1000 Section ...... ..0....~.--..~ ...... Block ...... ...'~. ........... Lot No ...... .~...~. ...........
pursuant to application dated ..... ..~....~.'~. ......................., 197..~..., and approved by the
Building Inspector.
.~,, /
Fee $. ! ................
Building Inspector
Rev. 6/30/80
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
,~OUTHOLD, N.Y. 11971
TEL.: 765-1802
197¢. Permit No./~ .~. ~.~....~-:
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19.
Date ................... 19
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,,Rr for removal or demolition, as herein described.
The applicant agrees to comply with ail applicable laws, ordinances,~/ding code,,,~J3~, code, and regulations, and to
admit authorized inspectors on premises and in building for necessary~p.~,~;:s. ~..
Fe' of applicant, or name, if a co p ' )
' ' // ..................... APPRO¥.ED 'AS' 'NOTED ....
v (Mailin~ address 9f applicant) i '
State whether applicant is owner, lessee, agent, architect, engineer, general''
(./'" .aa--cz- NOT FY BUiLDiNG DEPARTMENT AT
........................................................... 765-.180.2..9' 'AM' 'TO '4' 'P'M' FOR' THE
F OLLO
WING INSPECTIONS:
........... 1... FOGNDA'T-ION .-' "PWO · REQUIRED
v -
(as on the tax roll or latest d~gf~ POURED CONCRETE'
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 .......................
2. ROUGH - FRAMING & PLUMBING
3. INSULAT~qN
4. FINAL ~ Cr)N'STI4U"'mION MUST
BE (-'~t,,'tp[ ~-~E FOR C. O
ALL C(')NqTR',OTION SHALL MEET
Tt'IE RFOtIIRFMFNTS OF THE N, Y.
STA'r'c' C'"k~eTRUCTIOh! ~¢ ENERGY
cr~ ~ N"~T R~qPDh'q~g[-F FOR
DESIGN OR CONSTRUCTION ERRORS.
Other Trade's License No ......................
I. Location of land on which proposed work will be done ...... ~. ......
House Number Street Hamlet
q-7--zq /
County Tax Map No. 1000 Section .................. Block .................. Lot .................
Subdivision .... /~t~.~...t.~. ¢~...~". ............... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~....'~. · .~..~. · ., ~ ..~.. ~ ~ ..~: ...................
................... ~ ....... ~ ,~l
· e v . .....
b. Intended use and a:zuT, anay .... ~ . ~ ,
3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ...~ .....
' ..
Repair .............. Removal .............. Demolition .............. Other Wot . ..
4. Estimated Cost ...................................... Fee...~..."~'.
' i ,, _ 4, (to be paid on filing this application)
5. If dwelling, number of dwellingi~units~r ._:...]L~...~.~'..~at~t~umber of dwelling units on each floor ................
If garage, number of cars .... ~.. { .~..~/.~../.~. t':~ .................................................
6. If business, commercial or mixed occu~ pancy, specif~na, ture~nd extent of eac, h ty~pe of use ....."-~. ..... ,, ........
7. Dimensions of existirtg structures, if any: Front ..... ~;. 0 ....... Rear . .I~.~. ......... Depth..~,.~"..~. ........
Height ...... /. ~ .~. ....Number of Stories ...~ .....................................................
Dimensions of same structure with alterations or additions Front ...... ~. ......... Rear ..................
Depth ~ Height
· .' ................. ; ......... Number of Stories
8. Dimensions of entire new construction: Front ..... ~ ...... Rear . ~ Depth ''''
-'Height ......... ~,~'... Number of Stories . ~ ........................... .,.._~ ...............
9. Size of lot: Front ...... ~.~"~ .... ~ ..... Rear .... ~. ,.,.~70 ............ Dep[l~ . ~..I~[-~. ......... ~......
10..D, ate of Purchase .......... i. ~..~. ~:~ .......... N~e of Former Owner ~. ~/4rt~C... ~.-..~. ~J.9~-. · ·
1 1. Zone or use district in which pr?mises are situated ..... t~,.~'.~lt}ee~t~.~ .............................
12. Does proposed construction violj~e any zoning law, ordinance or regulation:~A~l~..'~. ~.. t,~... ~.~.
13. Will lot be regraded ....... ~' I~'' · · · ~ 't /t;~ ~ · · · Will excess fill be removed from premises: Yes
14. Name of Owner of premise~r~.. ~Ar.~.~. Address ................... Phone No ................
Name of Architect ......... ~ ................. Address ................... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly al1 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
inte~or or comer lot.
STATE OF NEW YORI52~/ .~ / .. ,.
COUNTY OF ,,.~,,~. i~'~ ' "" '
· .' ............ being duly sworn, deposes and says that he is the applicant
g~( (Name o f individual signing contract)
above named.
He is the . ,
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is du!y 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
.......... ~ ........ day of ........ ~ .... 19.~.
~ "~'~'~'~ i ....... ~. '..~ . County
dlJDffH T. T~RRY
No. ~s~.o~44ee3