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Home My WebLink About13174-z lro~v NO. ~ 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? 13174 Z Permission is hereby grcmted to: ' i...~.,.~....~.~.,o..,~ i ......................................... .~~...~.......~.:~..,.....~..~..~.~.~~ - ........ ........................... .... at premises located at .~.. .................. County Tax Map No. 1000 Section ...... L..O...O~. ......... Block ....... ~.~... ......... Lot No...J.."~""~'"'~"?'.'l- pursuant to application doted ............ ..~..~..~....~'.. ............., 19.~L.~., 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.: 765-1802 Approved ......... % .... Permit Disapproved a/c ..................................... .................................. .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. Date .................. , 19.. ~ INSTRUCTIONS a. This application must be completely filled, in by typewriter or in ink and submitted in triplicate 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 g/ring a detailed description of layout of property must be drawn on the dia~am 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 issue 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 Occupahcy 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, ordLnances, building code, l~ousing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary i~.pections. ) (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises..'~..~..L..r~. '...~.*...~...~....~...~.. :~...?... · '.~. · 5:..~..~. ~.°).4 ............ (as on the tax roll or latest deed) APP, If applicant is a corporation, signature of duly authorized officer. ~ ¥ -20 TED (Name and title of corporate officer) ~EE: ] ~, I~OTIFY BUILDING DEPARTMENT AT Builder's License No .......................... 785-1502 ~ AM 'TO 4 PM ~OR THE FOLLOWING IN?-ECTIONS: ]Plumber's License No ......................... 1. FOUNDATION - TWO REQUIRED FOR PO!JRED CONCRETE ~ ~ ROUGH . FRAM!NG & PLUMB}NG Electrician's License No ....................... ~ N.ULA Other Trade's License No ...................... 4. FIN.~1_ . CO~. ' ..... 'Crl,3N MUST BE C%'~[TM ~T~ ",~q C O. 1. Location of land on.~whicJ¢ proposed work will be done ............ /..,.1 L..CON?.rI~LIC': '.q~,! · 8~4ALI.. · MEST- ....... ltous~ Number Street CODES. ' ~l~t RHSP~NS BI E FOR DESIGN O,~ CON,.TR'JC ' C~hnty Tax Map No. 1000 Section .../9.~'. ~ ~ ...... Block . .0. ~,. ~ ~ ....... Lot.. 0~.'.¢9./. ....... Subdivision CCn~n/~ ~4~ Filed Map No. Lot (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ..... C.~I ~.%~ ................................................ b. Intended use and occupancy ......... . ...... ~ ..... ' ..... 3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration ........... , . Repair ............. Removal .............. Demolition .............. Other Work .~c I? .~..c. · · , ~-- (Description) 9. Id. 4. Estimated Cost . I. Fee ................ (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ....O....Itl:~,. ..... Number of dwelling units on each floor ................ Ii' garage number of cars 6. If business, commercial or mixe4 occupancy, specify _ntt~re and extent of each ty, pe of use .... .-T'....: ~..~,. :a ',' .... 7. Dimensions of ex~sting structure,S, if any: Front...~r~... ~ .... Rear . ~i~.~[ ......... Depth..~.. · · ~. ·. Height . .~ .'~'. ........ Number of Stories '. ..... [.Oq. ........ .:.: .................... i-' ' >,'Z' 2 ....... Dimensions of same structure w!th alterations.9.or additions: Front .~.~~. · · .... Rea~,.:~..~?bm~ ...... Depth. .... .-~l. ~ ....... Height . .~q..~,'~:~t~. . ...... Number of Stories....~'"2W...~.."~. · ......... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height'...............Number of Stories ....................................................... 9. Size of lot: Front ........... ! ........... .R~r ...................... l~epth ..... i.d ............. 10. Date of Purchase .. ~?.~: !~./.~'.~.~. ........ Name of Former Owner J~g~..~'. ~.q $1/..~ .......... 11. Zone or use district in which prem~ses. ~re situated .................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ...' .~2~. · ......................... 13. Will lot be regraded ........ glo ................. .Will excess fill be remo.v~d~eo~vremises: Yes No 14. Name ofOwnerofpremises .D/~.b~-.~..~'~ ·~r*..~.~.~,~[ed'dress .-:~'.~. ~/0/~'¢ · 'e'~°"~eN° '~'~¥'2:~c~' ..... ~ Address ~ Phone No. ~' Name of Architect" "' ............... Name of Contractor ........ ~.' ............ Address .....~. ... ....... . Phone No. ..77. ........ ... PLOT DIAGRAM Locate cleariy and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockl number or description according to deed, and show street names and indicate whether interior or corner lot. i STATE OF NEW YORK, ~ ~ COUNZY OF. 47'..0. F-/elK ..... ,' (Name-o~' individu'~l si~ning contract) above named. He is the ...... (~ .q.~'.~.. 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 ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the application filed therewith. Sworn to before me this 19 ~...f ........... ..... d. ar of... r-u.t. ........... Notary Public .......... ~ "''"~"~"'~' ' '" ' ' ~ ,11 · · '-'- ~¥ ~uOuC, State 0! New ¥o~k '~' ' ' "']['-- ' ' ' (Signatu/e of applicant)