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Home My WebLink About13355-z FOB]f NO. S TOWN OF SOUTflOI,.D 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? 13355 Z Permission is hereby granted to: ....... ........ ./.'a/~.~........~.~.~...~......~.~ .... .... .~.~7~.~..4~...=.~.: ..~..,.......,Z./..¢7/ County Tax Map No. 1000 Section ..(~.'..~.. ..... Block ...~..~... ........ Lot No...~.~...~.~...'. .... tO application dated ..... ~...~..~..~.. ............. .~...~.. ............... , 19~..., and approved by the pursuant · / Building Inspector. Fee $....Z: ................ Rev. 6/30/80 FIELD ~SFE~TION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ADDITIONAL COMMENTS: FINAL 'FORM NO. 1 ToWN OF sOUTHOLD BUiLDiNG DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 1197~ TEL.: 765-1802 roved a/c ........... <" ............ ...... . .................. ... (Building Inspector) ~EELICATION EOR BUILDING pERMIT Date .-./ff~" INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ·, e lot olan to scale. Fee according to schedule. sets of plans, a. ccur.at P. ,2~Hon of lot and of buildings on premises, relationship to adjoining premises or public streets which is part of this appli- b. Plot plan si~owmg ~u~ or areas, and giving a detailed description of layout of property must be drawn on the diagram cation, covered by this application may not be commenced before issuance of Building Permit. Such permit c. The ~vork d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied O[nsU. S;dcti~rwh°le or in part for any purpose whatever until a Certificate of Occupancy been ranted by the Building I p - . ~ ~...~. p~mit oursuant to the shall have g _ ~ .~. ....... ,-,~ c,x a ~,~,,,,e APPLICATION IS HEREBY MADE to the Building Department tot ut~ ~. 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectOrS on premises and in building for necessary inspections. . ............ · ' ' (~ignatur'e of applicant, or name, if a corporation) ..... (Mailing address of applicant) ' ~5'7 / State whether applicant is.ow~r~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... Name of owner of premises ............ ' ..... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate of~cer) , . :.-7 .... Builder ~ License r~o .................. , ~ Plumber s ,License No ......... '~t Electrician s License No ..... '/~'/ .... ~'" Other Trade's License No./.~.;./' ........ " ~ ...... ~-r0~>sed work will be done ................ ~ ~.~/. ..................... 1. Locationoltanaonwmc:~v v ..~.l.~/ff ........ .~.~6tff.]_~g ·/~)/.D..~... ~'~..it47..~. A~Z' ....' ......... Hamlet "" ....... ~ Street ' House Number " ........ Block ........ Lot ................. County Tax Map No. 1000 Section ..... ........... Filed Map No ............... Lot .............. Subdivision ................ (iq'a~)' ' ' ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .... ~ .'~ b. Intended use and occupancy ...... ' ~, ... '., -:,.' 10. 11. 12. 13. 14. property lines. Give street and block number or description according interior or corner lot. Nature o ork (check which apphcable): New Building .......... Ad&t~on .......... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work.. PC'... ......... (to be paid on filing this application) If dwelling, number of dwellinglunits ............. Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing struvtnr~s if any: Front ............... Rear .............. Depth ............... Heigh~ ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ................... ~.. Height ...................... Number of Stories '. .................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. · Height ............... Number of Stories ....................................................... Size of lot: Front ' Rear Depth Date of Purchase Name of Former Owner Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........................... Will excess fill be removed from premises: Yes No Name of Owner of premises .................... Address ................... Phone No ................ 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 to deed, and show street names and indicate whether STATE OF NEW YORK, ~. ~ - - (Name of individual sigffing contract) above named, j being duly sworn, deposes and says that he is the applicant (Signature of applicant) ._~e is the (Ce~tr~cter, ~gent, of said owner or owners, ~d is duly autho~zed to perform or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are tree to the best of his ~owledge and belief; ~d that.the work will be perfomed in the m~nCr set forth in the application filed therewith. Sworn to before me this ...... [. ~.~ .......... day of .... 19