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HomeMy WebLinkAbout13090-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? 13090 Z Permission is hereby granted to: ...... .... ~.~.......~.~.~.....~ .~.... ..... >~..~.:~~.. ............ .V. .......... ~..zl. ........... o ........... '~t ........... ~ ................................ ~:~t ....................... I ............. at premises located at .....~..[.-).?....J..O.... .L..'Mm~...~..~..].~...~.[.~... ............ County Tax Map No. 1000 Section ......°....~...~.~.. ....... Block ........ i~. .......... Lot No......~...:.../ ............ r-~..'~,~, ' pu~uant to a~lication dat~ . ~ 19.~...~., ~ approv~ by the Building Inspector. Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 .... , Approved . . .~\... {~ ..... 19..). Permit No ............ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely tilled 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 per~.it 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. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, gnd regulations, and to admit authorized inspectors on premises and in building for nece~a~ions. ~ -5~__~d_~ (Mailing address of ap~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises ~....~/~,~..t~ ~ .............................................. ~x~ (/ ~/ (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 .......... r-. .......... ~DoD~ }'r)°~ '¢ ~q'~ ~--~v,]~ 1. Locat' ofland on which proposed work wili be ~one ~/'~.~.~ ~//~t~ ~-~ ~.~ County Tax Map No. 1000 Section .............. ~..~. ·. Block ..... ~ .......... Lot ................... C~ · [' Subdivision / ~ -~ ~' . .............. ........ ....... i ..................... Filed Map No .......:...' .... Lot (Name) 2. State existing use and occupancy of premises and intended u~.se and occupancy of proposed construction: a. Existing use and occupancy ~ "~. '~ b. Intended use and occupancy ..... .~..x~-f.~4~.~..~__~. .......................................... 3. Nature of work (check which a ,plicable): New Buildlng~Addition .......... Alteration ....~. ..... Repair .............. Rem )val .............. l)enloldtion .............. Other Work ............... (Description) 4. Estimated Cost... ~ ...... i .......................... Fee ...................................... *" (to be paid on filing this application) 5. If dwelling, number of dwellingl units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................ : ............................................... 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories.. ....................................................... Dimensions of same structure With alterations or additions: Fronf ................. Rear .................. Depth. .................. ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... l-Ieight ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... i ........... Rear ...................... Depth .......... J ........... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone Or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ' STATE OF NEW YORK, !S.S COUNTY OF ................. ~ FEE:. BY: b, (;,/- NOTIFY BUILDING DEPARTMFNT A~ 765-1802 9 AM TO 4 PM FOR THE FOLI,.OWING I~JSPECTIONS: 1. FOUNr'Aq'ION - TWO REQUIRED FOR P"~LJR~D CONCRETE 2. ROUGH - FRAMING ? P[ [JMBING 3. 4. FINAl. c,'3F.Hq'FRt[" I©N MUST BE C~"~DI ['TF FQR C. O. ALL CON¢'~ r~r ~CTION SHALL MEET THE RFC, I~r,~MqNTS OF THE N.Y. STATE CONSTRUCTION & ENEP, GY CODES. Nr3Z RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERPr~,S. ............................. , .................... 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 cont~ned 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 ofi .... ~ .......... 19 ?,.~ NOT/~I~Y PUBLIC, State Of New Yprk, ' .... No. 4707878, Suffolk Com~t~ (S:gnature of applicant) J Term Expires ~arch 30, 19~(-