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Home My WebLink About13491-ZTO~VN OF $OUTHOLD 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? 13491 Z Permission is hereby granted to: .... .~./..~....~~ ..... / ........... ~..~.......~....~~.~ ...... ~.~...~~ .................. Count/ Tax Map No. '000 Sec,,on ...~...~.... .......... Block .....~ ......... Lot No...J....,~T..J ......... pursuant to application doted ..~...,~..........~.......~.. ..................... 19.~...~., and approved by the Building Inspector. Rev. 6/30/80 FIELD I~SPECTION FOUNDATION (1st) FO~.NDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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- ation. 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 hall be kept on the premises available for inspectiou 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 hall 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 luilding 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, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inSl~ctions. , _ (Si~ff~ture of apgljcanth oInan~alf_a.c, or/lo_rallon) (Mailing address of applicant) ~tate whether applicant's owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises .4.C)..~'>~...~'.{ ...c:N~. ~ ~.~ ...... .c~.....~,..~ ................................. (as on the tax roll or latest deed) 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 ...................... i. Location of land on which proposed work will be ne... CtM..~.. . ~ __C~oJ~ ~ '/' ...... ' }f .................... ir;;i ....................... ........................ County Tax Map I~;. I000 Section .... .(~....'~.. ...... Block ....(~...~...-~. ....... Lot ...... ~ .[ .1-] ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupanc~of proposed construction: a. Existing use and occupancy .... .~. · '~-~' .~ ~.9,-A'~.~...([Dr4~....e-~....~.~ ~.~&.~.'~ ................. b. Intended use and oclUpancy .... ,~..1.1.C2~...'2x."'.~,-. ..................................................... 3. Nat re of work (check winch a_p~al~Le): New Building .......... Addition ........... Alteration ......... Repair ............. (:~R~oval. ;.~ .......... ~ ............. Other Work ....... .~ ...... ~t~__ =--~--~ (Description) 4. Estimated Cost ....... ,.~.'.~.C~.C,:~.,..e,~..~).... i ............Fee ..................................... (to be paid on f'fling this application) 5. If dwelling, number of dwelling units ............... 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 structures, if any: Front ............... Rear .............. Depth ............... I/eight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ' Rear ..... ~ Depth Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. 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 ........................... . Will excess fill be removed from premises: Yes Ne 14. Nme 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 all 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 YOI~I~, COUN-rY, _OF. ! k. s. s ......... ~.[ ~ ¢'[?~ ~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........ ~.~} . - .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or ownen, ~d is duly authorized to perfom or have perfumed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfumed in the manner set forth in the application flied therewith. Swum to before me this Not~ Public .......... ~.. ~ .~: ~; County~ , ~ ~OI~RY Ptl~l lC, .;h~le n~ New Vo k ~