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Home My WebLink About13362-z FORM NO. O TOWN 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? 13362 Z Permission is hereby granted to: ............................................ /-x · .~) at premises Iocoted ot ..... ..~..0.? .......... ~. ~.....~' ...~.~......~../~ .......... County Tax Map No. 1000 Section ..... .~....~...~. ...... Block ...... .(~.....'~.. ..... Lot No......Q.I.~ ......... Building Inspector. Fee $..~. .................... and approved by the Building Inspector Rev. 6/30/80 ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7§5-1802 196[ oJ. 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 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 inpart 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ,TWIN FORK FENCE ,QONIPANy ....... ''' i~i'g~i~r'e'~ ~~c~;~}0~t~ c~p"ation ) ,~¢£" ~/? 7~ ................. ~..~ ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No .... .~..~..~?. ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Name of owner of premises ./~/..~. ?.....~..'rE./..~.. .... .~. (.~.4..~. ~ .............. ,~,.., ,..,~ ........ ~ .......... (as on the tax roll or late~ If appl~nt is a corpora, signature of duly authorized officer. ................................. NOTIFY B~JILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNmATION - TWO REQUIRED FOR PQURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INqULAm~QN 4. FINAl. ,. O~'?;FP~I~FION MUST BE Cm~zP~FT~ FOR C O. ALL CONq-r~'CqON SHALL MEET THE REOIURrMFNTS OF THE N,Y. ]. Locafion o[ land o~ which proposed wo~ will be done .............. ~TAT~. -G~N.STR.UGTION- .~ · ENERGM ..... ~ ~ ~¢'~¢.-¢~...P~. ~ -,,. ,~,~/~ co~s. ~Fr ~ES~O~S~L~ ~OR ........~0 .... . ....................... DESIGN .~.¢~NSTA. U~TION' ERRORS; ..... ~ouse Number Street ~amlet Co..ty T.x ~.~ No. ]000 S~tio. ...... A A ~ ....... mo~k .... ¢.~ .......... Lot.. ~ {.~ ............ Subdivision ................ (~.~/ ................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy o/Proposed constmctJom a. ~x/sting use and occupancy ..... .......... ~ ~.. ,~ .~ , : ~ f ............... 3. Nature of work (check which ap'plieable): New Building ..... ' ..... Addition .......... Alteratlon . ~. '...-' ..... Repair .............. RemOval ............ Demolition ......... Other Work 4. Estimated Cost ~.~..O0.~ .............. 5. If dwelling, number of dwelling ~nits ........... (Description) ......... tee..,, .......................... "-, (to be paid on filing this application) ·. Number of dwelling units on each floor ................ It' garage, number of cars ..... i ................................................................. 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur{s, 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 ...........i ........... Rear ...................... Depth ...................... 10 [)ate of Purchase ' Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. r)oes proposed construction viohte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No Name of Architect .......... i ................. Address -%,,~4~ old . . Phone No. Name of Contractor 77,¥/a¥..~.o.~.~'..xxxxxxxxxxxxxxxxxx~. ~. ,~'q..d,~ .... Address .' .................. Phone No.,~..~.~.; .~? 2.7. .... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from amber or description according to deed, and show street names and indicate whether /6'--O /00~ . Z //V~P~..ff' .~..~.~.~.'.o ........ being duly sworn, deposes and says thst he is the applicant (Name of individual sighing contract) above named· % is the ..... ~ .......... d./.O.~..w~.4~,. ~ ................................................... ...., ~ ~(C°ntract~2L~gent ' c°rp°rate ° fficer' etc') . of said owner or owners, and is duq.g.~authorized to perform or have performed the said work and to make and file this application; that all ~tatements 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 ........... X,~-~ ..... dayoI ..... ; . .., 19 ?.~. Not. j~y. Public ....... ~ .... ~ '~-.' ' '~' k County ,