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Home My WebLink About13446-Z /0~'~' 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? 134~6 Z Permission is hereby gronted to: £ . ......-~..a.~:..~...~. ................................................. ...... ........................................................................................... ¢~n~ Tox Mop No. 1000 ~c,~on ....... O..~.~ ..... m~k ........ ~ ........... ~ No...~.;...I ............. pursuont ,o opplicotion dote~ .o..~(~,~....J.,~.-- .............. , ,9..~....~o, ond opprove~ by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~.~.~ ~ .~ .... 198.4. Approved . .~.. ~.'~.[IJ~...').~ . ~, 19 .~.~. Permit No ............ Disapproved a/c ..................................... Received ........... ,19... (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 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 tlzis 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 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, addiQons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaD,~inspections~ ~ ,~ t 'g pp 'cant, or nam'e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises... ~...II'A~...~.:...~..~ .~. ~ ......................................... (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 License No ............... ........... P umber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be doric .................................................. }louse Number Street Hamlefi County Tax Map No. 1000 Section .................. Block .................. Lot ...... · ............ Subdivision ..................................... Filed Map No ............... Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. x~stmg use and occupancy ........... . ............................. b. Intended use occupancy . . ......... · 3alteration .......... Addition . · ' other Work ............. · . ~,~,~, .......... (Description) -,-/check which apphcabie)..N, eW Bu gDemolition '£ ............ ature of we,- · RemOVal .......... ~ t/~ ~ .................. ....... · .. (to ~ - · .......... of dwelling ' 4. Est~ated Cost .... Number .... ,~,mm, ~,m~ o~ ~u,~ m,, . . .......... : ;i~i ;m~ o~,~h ~ o~,~ %;¢ ' th ......... business, commeim~ ' '2 i2~ ear .............. ' '' ' ..... 5. [(~'~.e numbe~ of c~S · · ~ unanCy, speedy nam g ........... ~ ' ~m°~'~ ~ ~ ~'.'.'.',~ ............ .2'. ..... ~" ' .... 6. If existing stm ' : · ' ..... . ........ ' .... 7. D~ensionSOf ohS: F tofie ..... . ...... i2Yn same stmcture wi2 ~ .... Depth ...... sionS of et~t · · ' Rear ........... . ...... Front ............. ' ' ' ' ' ' ' ' ohs of entire new const~Ctton. ' ~n&i . Number el Stories ..... ''" Depth ........ s. am~ ............ ' ..... am.. ~i;& ;~o~, owm ....... [[ .................... 9. Size of lot: Front .......... ' .......... ~...j ............ [ · ':' '.] 11. .. phone No. 12. Do - ~ ............ . Address ................ ].. phone No. .............. . phone No ................ 13. W¢1 lot be regraae ..... ' ....... Add~ess .............. N~e of Owner of premises ....... . ..... . ....... .... . Address ........ N~e of Archxtect · - ' . ........ N~e of ContractOr ........... pLO Locate de~lY ~d dis~Ctly' ~1 bufid~gS, whemer existing.? ptope~ Bnes. Give street md block number or description accoramg to ~ , interior or corner lot. ~OTIFY B~JILDING D~PA~T~ENT AT 765-1802 9 AM TO 4 PM FOR THE ~OLLOW~NG IF 'FPECT~O5,'~: J. FOUF?A~qON - ~ FO~ [~tj~m~ CONC~T~ ~. ROUGH: ~RAMING & PEUMBING 3. INFIB ~. FINAL CQ~?QTR~*CZ~QN MUST BE C~Mm~-'r[ FOR C.O. THE REO~{mrMFNTS OF THE N, STATE CONSTRUCTION & CODES. NOT RESPONS~BI E F~r~ DESIGN ~R ~o~,~q-'PHCm~C~4 sTATE OF NEW yoRK, S.S being duly sworn, depOSeS and says that he is the applicant ' ................ of said owner or ownerS, and is duly authorized to perform or have perfOrmed the said work and to make and fie this forth in the application filed therewith. application; that all statements contained in this application a~e true work will be performed in the manner set Sworn to before me this 19 .~,.~ ·. .day of .... ' ..... unt , .... ......... /- · ' /_ Notary publ!c~, - ·