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Home My WebLink About13138-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ~I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13138 Z Permission is hereby granted to~ ..... ~..~.~..~.~ ....... ...~.~J.~,L... ............... ......~.~.~.....~..~..~ .............................................. ' .~~~., ...... ~..~..~..~...~...~..&..4...~......~... 'on . 0 <::) ~ lock (:~ ~ Lo o .~,/''~ County Tax Map No. 1000 Sech ..~ ................... B ...................... t N ....................... · . ................ ~-i ......... ./ ..................... .~. 19.~....~.." onda roved b the pursuant to appl cahon dated """'{1-'"'""' . , ., pp Y Building Inspector. Rev. 6/30/80 H~¥ ~4, t984 '({~ u( i L d i n <j D e p a~ I" '~' m e n *( ,'~'ou'l'ho I.d, New York Dea¥' ,? i ~-,s', Eric I.o.?ed i .s' i'he fo t. I. owi ng document'at' i on re La'~ed i'o ,~ I.'~:er~'.~i' i on p l.,:.ln.s' l'o my home on I::'i~Fl'le¥'~' I.s'l.~nd: Bui Lding permi't ~)l:~l:~l.i(::~)'[ion Three .s'(.:.!'~'~ of pl.,'..~o.s' c:on'l:ail'~ing ,':ll.'~'e:ra'~'ion .~pe(::ii:ic~'~'ion.!; Che(::k for .$2!]~ (.)(.) '~'o coyer app 1. i(::a'l: i(:)~'~ fee for l'h i.s' '[ype o'f" The ¢:te:;~ i ~"ed ,~ }.'hz, rat' i on.s' i nc I. ude rep Lac i (~pproximate ~'iz(.:.): 8 f'{'~ x t6 ff.,) wi't'h a F~"ef~H:)~"i(::ai'F.,d a't'l"ium (apl:~Foxima'fe .!~iz(.:.): ~() 'F't',. x t6 'fi',), buil. di~'~g .s"t'air$' 't'o fa(::il.i't'~4't'e rear a(::c:e~'~; and (:~x't'eFiding i'he exi~"t'ing coy'nice Any ,'..H:h;li'~'ion~:ll. info}"ma'I'ion i~' )"e,:l. Ui~"ed rel. a'~:in,~:~ '!'o 't'hi.s' ~lppl. ic,.'..i('ion can be made by phoning (2i2) 88S-!:.~i9(') du¥'ing nol"mal. I:)u.!~ine.~Ls' I'H:)ui"~' o~- a(:h:h"e.~rs'ing }"e,:l.~e~;"[ '{'o I::'~0., Box 66B, F:'i~'he)".s' I.s'l. al'~d, New Yol"N, (-)67~9~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .... . .~.' '~;.. ... . .... i", 19X.'J. Permit No.~ ~.].~..~..b. Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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. ¢. 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 re ,mova~emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building copej nous~njg code, a/aa-~eg~lations, and to admit authorized inspectors on premises and in building for necessary inspections_,.t.Z ........ 7C ' n""- (Signa/tdre of applicant, or name, i~ a corpo ' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ................................................................................... Name of owner of premises. ~ f.~..'~.....'~...~...' '~'~' '~7' '~' 'q''('~' . . ./~.o.~...~. ............................. (as o'n 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 ...................... 1. Location of land on which proposed work will be done .................................. %., ;..,-,-,..., .¢,.. ,.~... ....................................... ,';-. i-. :. :'.-: House Number Street Hamlet ..... '~?' , ~" County Tax Map No. 1000 Section ~)~) ~ Block 0 ~ _, -_,~/; z-.~::~ '- : x-. .................................... Lot ...CK. ~ .o. .... .,: ,., .... Subdivision .............................. ' ....... Filed Map No ............... Lof ', -.': ........ (Name) 2. State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occupancy ....~..t'..r~...a,~..e~...~.....~.d.,.r?.a,. f.~.....~..~)..~..~C4 ..' ..... ................... b. Intended use and occupancy ...&~. · .g~.'..~ .... . .m,~..,.~. ...... .~.[d~.~'. ......... 9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Remgval .............. Demolition .............. Other Work ............... (Description) · Estimated Cost ....... ~ .O.t?..'.O.,..~.. .................. Fee .~.~.5.: .~.~.. (to be paid on filing this application) If dwelling, number of dwelling units ...... /. ........ 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 qxistin~g structur{s, if any: Front .... ~..~.~7 .~ '.~ .... Rear . .~t.~..T .~.' ..... Depth . .'~../..'7.°. 7: ..... Height . .~ ~ :.% .o ...... Number o f Stories'... ,,~ ................................................... Dimensions of same structure with alterations or additions: Front ....'~.2....3. ....... Rear... ~.~....~. ........ Depth .. ~.. ! f.~..O..~/. ...... : / ~ ~/ · .... Height ..... .~..3.. .... ~. ........ Number of Stones .................... Dimensions of entire new c.onstruction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories . [ ........ ., ~ .......... , .................................. Size of lot: Front ..... /.'~ .~../, ............ Rear ...... /..~. O. ( .... ~ ..... Depth . .~. ~...~ ............... Dhte of Purchase ..... ................. Name of Fo mer Owner .... Zone or use district in which pr~mises are situated ....................... ;~ ............................ Does proposed construction vie!ate any zoning law, ordinance or regulation: . tq/.P ........................ Will lot be regraded ....... .~. ................... Will excess fill be removed from premises: Yes Name of Owner of premises /~. o~..~...d..~ ...... Address (.o: .~.,~. t.t?: .~.'.'~.'~..~/.'P.'~. Phone No.~.t .~).4.~.~r fC~.~.~Q· Name of Architect .......................... Address [ .................. Phone No. (.~., .~? .~.8.~. ~ .~.~.q?. Name of Contractor ........................ Address ................... Phone No ................ LOcate clearly and distinctly al property lines. Give street and block interior or corner lot. PLOT DIAGRAM 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 STATE OF NEW YORK,, COUNTY OF j}t.~. ,U~/,. ~, ,O,~,/:.., [ S.S - ...... ~.q../~.4..~.2.~.. ~.0&~l ..................... being duly sworn, deposes and says that he is the applicant ~ (Name o f individual sig~ing contract) above named. He isl the ..... . ................ ~ ......................................................... ~ ........... ~ (Contractor, agent, corporate officer, etc.) ~ .owner ~, ~d is dqly authorized to perform or have perfo~ed the said work and to m~e ~d file this applicati, oa; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the wor~ will be perfo~ed in the m~n}r set forth in the application filed therewith· Sworn to before'me this 2¢ .... ............ : k2 d 2,t ? .... ........