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Home My WebLink About13352-z FOBlt~ NO. ~ TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13352 Z Permission is hereby granted t~: , ~ I "~'"~'~'"',"~ ................................ z ........... .....~.~.....~.~H.;....I..L.%~..~ ..... ...... ..... ~s ~ ~ ..~_~ 1~..~.~,_ at prem ses ocatea at ......................................................................... .,. ........................ County Tax Map No. 1000 Sectio~,_~.L.O.....~. ....... Block ...... !....O.. .......... Lot No.....c~.*..'..~.. ...... - ,-- ~ ~,~1 (4~7~ / D .... 19 ~. and a roved b the pursuant to app cation aatea ..... ..-~....--..~..-;.;~ ............................... , .... '1', PP Y Building Inspector. Building Inspector Rev. 6/30/80 Examined ~(~ .~q..~..I.4..., ApprovedQ~.u~..~' .}..t/. ., 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 19 .q. 19~..~. Permit No. ! .~..~.?.~...~-. Disapproved 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 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 st'~eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap. pti- 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. aTdhme i:papu~itze~ri~es;Jc~t~cr~sm~pn~yprewjmtihse~ana~pi~cbaubi~ed.~ma~v};;~deicne``s~inbsu~edi1~.~n~.~de~ housingt~f and regulations, and to ................ ~ (Signa~t~re of applicant, ' r~tl'~} i;~ corporation) (Mailing address of applicant) Statp whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ..... .................. ................................................. (as on the tax roll or latest deed) 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 ....................... Location of [and on which proposed work will be done .................................................. House Nmnber Street Hamlet County Tax Map No. 1000 Section ..... /..0..(e ........ Block .../.0 ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy o~ premises and intended use and occupancy of proposed construction: a Existing use and occupancy .[~'!~.~.'~ ].~.~.~./U..'~... ..................................................... b. Intended use and occupancy . .~. ~..~..~./..p~[ ~. ~T. ,.C..~. ........... .~.~.' .~..O.~. ~..~.( }ff.....Z./ ............ / 3 Nature of work (check which applicable): New Building ' Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work. ~-t~..gP.d.~. ..... 4. ....... ' *" (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, commercial or mixed occupancy, specify nature and extent of each t~ of use . J ,--- 7. Dimensions of existing structures, if any: Front ...... \ ........ Rear .............. Depth .............. Heig ............... Number of Stones ....................................................... Dimensions of same structure with alterations or additions: Front ...... .~. .... Rear ................. Depth '~ Height ~--- Number of Stories 8. Dlmenslons__qf~ entire new construction: Front. -' · ....... Rear ..... Depth ..... :7.: ....... Height Number of Stories '77:.. 9. Size of lot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase ......... . .-:7~-. :". ............ ~,.. Name of Former Owner ........ . .'~...': ............... 11. Zone or use district in which p~emises are situated .~'. ..... ~ ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .................. ~ ......... 13. Will lot be regraded ........ i ................... Will excess fill he removed from premises: Yes 14. Nameof Owner or pr,.ejnise, es .~... f't~./~& ~'~ddress~2. e~4~ . P~.~.- ....... Phone No..~..~.'T~.fi..~(~... Name of Architect .~./-].~ ~ - .-~.-%" Address . phrm~ Name of Contractor .~.~. .... ! .................. Address ................... Phone No ................ Locate clearly and distinctly property lines. Give street and blocl~ interior or corner lot. PLOT DIAGRAM ali buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether __ APPROV£D AS NOTED ~ DATE: . B,P .~ .... FEE:__ BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2.ROUGH ~ FRAMING & PLUMBING 3.INSULATION 4. FINAL ~ CON'STRUCTION MUST BE cr~MpI.ETE FOR C. O, ALL CONSTRUCTION SHALL MEET THE REQ~!IREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR STATE OF NF~/Y./~R~(,~ 'S S DESIGN OR CONSTRUCTION ERRORS COUNTY OFO.~.'.*~...g lq-. ...... i ' · .?.~f.~.P..~... ~ ~....~ .-r .' .................... being duly sworn, deposes and says that he is the applicant (Name of individual '" signing contract) above named. He is the ...................... , ................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conthined 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 ........... '0. '..~ ....... dayoi ..... ~ ....... , 19 ~.~ · ............ ~,,,. ~101}10~S,ttm e, um 1_ (Signature of applicant)