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Home My WebLink About13153-z ]~OB~ NO. 0 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13153 Z Permission is hereby gronted to: .....~_~ ~c,~c~;./....Y....~.c .............. .~... ...... .......... ...Z~.]~..~....~..~.~ .................. ,o ....... ~.z~_~_.........E.~.,~e:..~ ....... Z~ ......... ...~..~././~...........~..~.~/z..~. .................... County Tax Map No. 1000 Section ..~%AK~'. .......... Block ...~..~.. ......... Lot No.(~.~.~..~....(~./,O-'~' pursuont to opplicotion doted .... ~-/f/~K~,~...~,,~,,. ................... . 19..~,,~,,~ ond opproved by the Building Inspector. Fee $..,~..~....~... / Building InspeCtor Rev. 6130/80 FInD ~SPECTION DATE COMMENTS FOUNDATION (1st) ~OUGH FRAME & , .~ PLUMBING INSULATION PER N. Y. ,,.. STATE ENERGY ~ODE ADDITIONAL COMMENTS: , 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved Pe it No ............ Disapproved a/c ..... : ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received .... .'~../.~...~19~. Date ..... ¢ ...... ~..g' 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 in part for any purpose whatever until a Certificate of Occupancy shall have been granted by tile 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 corse, housing;code, and regulations, and to admit authorized inspectors on premises and in building for necessary in~l~cti~.//~// .. .... ............ (Signature of applicant, or name, if a corporation) ... ~.~: .~x.../.~..~...x..S~::.4 ?.~../.d./..~.~. ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engjneer, general contractor, electrician, plumber or builder. ...... .................................................................... Name of owner of premises . . .~(~//~t.q . ./tt~.~o..,-~ .................................. : ................... (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 LicenseNo...~.~. .................. Plumber's LicenseNo ......................... Electrician's License No ....................... Other*rrade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . ....... .... ................. . 14 ..................... House Number Street Hamlet County Tax Map No. 1000 Section ....... ~ ..... Block ....~. ............. Lot...././..~.../.O. :5... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy... ~t;'~,...~/¢ .~ ..................................................... Intended use and occupancy ...... ~.'."~.., .... b. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ~'...~g, ..... ~.1./ [ ~.. ~.~ (Description) 4. Estimated Cost ..... ~.0...i ......................... Fee .............................. i (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... 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 type of use ...... ~ .............. 7. Dimensions of existing structurqs, if any: Front ............... Rear .............. Depth ............... Height ............... Nunlber of Stories.. ....................................................... Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth i Height Number of Stories 8. r)imensions of entire new construction: Front ............... Rear Depth Height ............... Number of Stories ........................................................ Size of lot: Front ' Rear Depth [)ate of Purchase ' Name of Former Owner .... Zone or use district ~n which pr~mmes are s~tuated ............................................ Does proposed construction, violate any zoning law ordinance or regulation: ~JP. ............................ Will lot be regraded .... 1~..j ........ , ........... Will excess fillbe removed from premises: Yes No Name of Owner of premises . Plal~t~ ./~.~4~.,-~. ..... Address tda~.~. ~.~. ! ~.~.{.t,~/.d.. Phone No ................ Name of ;~rchitect ' .~-,~$~w-i .~i .... ~.t~.~..~ ............ ~/.g~ AddressAddress .................. ..Phone No ................ Name of Contractor . PLOT DIAGRAM Locate clearly:and d~stmctly all buildings, whether ex,sting or proposed, and, ~ndmate 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. 10. 11. 12, 13. , 14. STATE OF NEW YORK, COUNTY OF ......... .'(Name of ]ndwldual slgnlng contract) above named. being duly sworn, deposes and says that he is the applicant He is the ' ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements cont/dned in this application are true to the best of his knowledge and belief; and that the work will be performed, in the mannelr set forth in the application filed therewith. Sworn to before me this . _ ........................ day .,,..._. .......... ,HELEN R, D~ VOB,l~i ..... N~ ~?~'~878, Suf(0~k Coun~ Term Expires Mmch 30,