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Home My WebLink About13343-zTOWN OF Sou'rHOLD 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.o 13343 z Do,e .. .~~......~.~ ............... Permission is hereby granted to:, j/~ ~ · ,.~ ~'-~"~-~ .................................... ...... .............................. ~ premises I~ot~ ot ....~ ............................................ co~,~ To~ ~0~ ,o. ~o0o s,~,~o~.~..~ ...... ~,~k ...... 9.~. ....... Lo~ ~o ...... ~.9..~ ........ 8uildl~ Insp~tor. Rev. 6/30/80 'FORM NO. 1 ToWN OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL soUTHOLD, N.Y. 11971 TEL.: 765-1802 )isapproved a/c ..................................... .......... (Building Inspector) APPLICATION FOR BUILDING PERIVIIT i ill INSTRUCTIONS · ' must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a. This apphcat, ion, ~ ,__ to scale. Fee according to schedule.. ,-*:-~ohD to adjoining premises or pubh.'c stree,t.s sets of plans, accuram plOt prim. of buildings on premises, retttttust, ~ ........ ~,;,~h ;o ,,~ of this appn- ~, ~lnt nlan owing location of lot and .... ~tv .,,,~t be drawn on the olagram wm~ .... ~rt u ..... v--- sh - ~ .~ ~ ~enrlntio~ of layout O[ prop¢--J , or areas, and glv~g a aetmteu u~--r- - menced before issu~ce of BuRdhg Permit.. cation. ~s a licat~on may not be corn . · · · pemit to the apphc~t. Such pemit e. The work cove?~ P~-~,Y~tion the Building hspector wall ~ssued a Bu~dmg d. Upon approval oI tins app~~v- , sha~ be kept on the premises avaaa?e for ~sp~ction throu~out the work. ' Ce tificate of Occup~cy e No bufld~g shall be occupied or used m whole or m p~t for any purpose whatever until a r ehM1 ~ave been granted by the Building Inspector. · ..... :~,~nca of a B~ldin~ Pe~it pursuit to the ........ --~,~ x~anE to the BulldOg Dep~tment ~qr u~,,~y-k~ ~ther appbcable Laws, Ordinates or ~PLICAT?~. IS ne~fi2~ of So.thorn,Suffolk County, mew xor~, ~,~ or demolition, as-hereto a cdbea. Bffilding Zone ummanCe m ...... ~d regulations, and to Regulations, for the constmc~on of bu~d~gs, additions or Mterations, or for removM The apphcant agrees to comply with aH app~cable laws, ordin~Ces, bu~d~g code, housing code, authorized ~specto~ on premises ~d ~ bulldog for necessa~ inspections. .... .. ......... admit ............ ,~.~.~ (Signatuie of applicant, or hame, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, ~chitect, en~neer, general contractor, elect~cian, plumber or builder. . . tg,¢~ ............................................................................... N~e o~ o ( , ~¢' If applicant is a co~oration, signature of duly authorized officer. "~t~(~ame and title o} corporate office ) Builder's License No .......................... Plumber's License No ........................ 765.180.9 9 AM TO 4 PM FOR THE FOLL owING IN .... CTIONS. 1. ~OUN~ATION '- TWO REQUIRED For>` pOt!R=D cONCRFTE 2. kO/lG~q ' FRAMING &*pLuMBING 3. INSU-Ar'Irn'NI Electnman License ~o ................ I AL Nc~¢~']~Y*0¢I ? ,ALL MEET Other Trade's License No ..................... , ' ation of land on which proposed wor~ ~tt ~ aoX. ( ......... Street House Number ~ County Tax Map No. 1000 Section .... ~.~ ....... Block ................ ~ p N .... Lot .............. .... / . Filed Ma o ........... Subdivision .......... ' ............... (Name) .- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occup Y.. -~ ......... -, / ~anc ~~. b Intended use and occupancy .................... 3. 'a!l~:~f yLql~ (~ch~ec~ whic~applicable): New Building ..... ' ..... Addition.. ~ ....... Alteration ....... ~dk~l~/~l.,:a..,~&,., gqfl t0val . .~ ........... Demoht~on .............. Other Work ...... .............................. ~l.__~. ~. llLt li - (to be paid on filing this application) 5. '. ~~i~i ?nits ............... Number of dwelling units on each floor .......... , ..... '~~... ~; .................................... 6. f business, commercml or m~x ~.d occupancy, speedy natur~ and extent of each typ~ of us~ ..................... 7. D~ensions of existing stmctur ~s, if any: Front ............... Rear .............. Depth ............... Heigh~ ............... Number of Sto~es ........................................................ D~ensions of same structure ~ith alterations or additions: Front ................. R~ar .................. D~pth ................... ~.. H~i~t ...................... Number of Sto~es ...................... Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... : H~ight ............... Number of Sto~s ........................................................ Size of lot: Front .......... ~ ........... Rear ...................... D~pth ...................... Date of PNrchas~ .......... ~ .................. Name of Foyer Owner ............................. Zone or use district in which pr~mises ar~ situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ L ................... Will excess fill be removed from premises: Yes No N~e of Owner of premises ~lr~. ~.~F~.-F~F~ddress J[o ~ ~ [ ~ ........ Phone No2~ ~. ~ 2.~ ~ ...... N~e of Architect ......... [ ................. Address . . ~ ................ Phon~ No ................ N~ of Corruptor. ~.yZe.~er~ ~ ..........Addr~s~ .~. ~ 5~,~Z.~.~4~<~. Pho~ No, . ~ .... ~ Y.$ .... -8. 10. 11. 12. 13. 14. Locate .clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether STATE OF NEW ~ORK, COUNTY OF ............ ~S.S ............................ ~ .................... being duly sworn, deposes ~d says that he is the applicant (Name of individual sig~ing contract) .. above named. He is the ..................... ] ................................................................... ! (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly autho~zed to perform or have perfomed the said work and to m~e ~d file this application; that ~1 statements conthined ~ this application are true to the best of his ~owledge and belief; ~d that the work w~l be perfomed in the m~n{r set forth ~ the application filed therewith. Sworn to before me this~ PLOT DIAGRAM interior or corner lot.