The URL can be used to link to this page

Home My WebLink About13210-z FOB,~ NO. B TOWN OF SOUTHOLD I~UILDING DEPARTMEHT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEI:LM, IT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) N.o 13210 Z Permission is hereby granted to: ................ ....................... ~t premises Iocoted ~t ........ ..~.. ...... : ......................... County Tax Map No. 1000 Sectio~ .....~....~....~. ........ Block ........ .~ .......... Lot No ..... ~ ............... pursuant to application dated ..... .~....~.. ........................., 19..~...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Iit 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ,xamined . ~ ~--.[.~ ...... , 19 .~.~. xpproved .~. I ..... , 19/.q. Permit No. ! .~..~. ! ?..-7+.. )isapproved a/c ..................................... Received ........... ,19... · (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........~/ff. .....19d~./ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. 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 roll 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 lall 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws~ Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, bufldi~code,, housiFg)cgde, and regulations, and to lmit a~thorized inspectors on premises and in building for necessary ins~ecgerons. "~r~~~' '~ '-~ d-&~ (Signature of applicant, or flame, if a~corporation) (Mailing address of applicant) 'tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 41~'of owner of premises..~.~-.~..~ .... ~'. · ~..oxid. 4L4~ · .~22, · ~;,~c. ·: ................... -- ~/ (as on the tax roll or latesf'deed) , f 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 ...................... APT?,:>T. 3 AS NOTED FEE:) ~~.~ ........ BY: ~_~ ,~,L, NOTIFY ~UILDING DEPARTMENT AT 765-1807 9 AM TO 4 PM FOR THE FOL[ ~WING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOq P~UR[D CONCRETE 2. ROUGH - F~AMING & PLUMBING 4. FIN',} - F~'~T~UCTION MUST Location of land on which proposed work will be don~e ................ 135..('.\??[ T'T? .EOR. C. O .............. ,-~ / ~ . , A ~ ,' , ,. ~N Sr-{ALL MEET LL ~ '"~'"~' 'r'~' ' ...... ..... ....... House Number ' / Street STA ~ E ~%TRUCTION & ENERGY CO~ES. NQT RESPONSIBLE FOR Co.nty Tax 000 section ......... mock ..... 0US[ U. .m OSS ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ~. ..................................................... b. Intended use and occupancy ......................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ........... Alteration ~ ......... Repair .............. Removal .............. Demolition ............. Other Work. ~~., 4. Estimated Cost ..... .~./.~. ~ ~). ...................... Fee ....... : ............................. b~p ' ' gth' ppr ' ) '~ '(to aid on fihn is a lcation 5. If dwelling, number of dwelling units ............... Number of dwelling ufiits 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 structures, if any: Froht ............... Rear .............. Depth ............... Nmnber of Stories Height ....................................................................... with alterations or ~tdditions: Front · Rear Dimensions of same structure ...... , ........................ Depth ...................... Height ...................... Number 9f Stories ...................... 8 Dimensions of entire new construction: Front Rear i Depth Height ............... Number of Stories ................ ? ......... ~ ......... ) .... ~ .............. Sizeoflot: Front ..... 7.~. / Rear ....... .7.,57. i Depth ~..(~. Date of Purchase ............................. Name of Former Owneri ............................. Zone or use district in ' ' ' which premises are s~tuated ....................... ~ .............................. Does proposed construction violate any zoning law ordinance or regulation: Will lot be regraded ....... : ..... ... ~ .., .......... Will excess fill be removed from premises: Yes No Name of ~rchitect ........................... Address ............., 1 ......Phone No ................ Name of Contractor~tq/&J. ~CT~..~&OlZ. C~ .~O. ..... Address ~..~/~IF.~.~'0~E~. Phone No.7~Q 7.": c:2¢>.~.~... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly ail 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. STAIEOFNEJ OR , . ~ Y K COUI~rY O~.' .... S.S · .~:..: f.~.~.. ......................... being duly sworn, dkposes and says that he isthe applicant ~ (Name ofindiqidual signing contract) above named. He is the ............................................................................. (Contractor, agent, corporate officer, e!c.) 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 contained ~ this application are true to the best ct his knowledge and belief; and that the work will be perfomed in the manner set forth ~ the application filed therewith. Sworn to before me this