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Home My WebLink About13904-z I~OBM NO. ~ TOWH OF SOUTHOLD BUILDING DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- i3904 Permission is hereby granted to: ~J~:.~..~,z.....~//,~ ~..~,~...~.~....~.~......, ................................ ~..~.............~.. ~...../...~.....~. ......... ~...~/.......¢.~......~'. ......... ~ ..................................... CounW Tax Map No. 1000 Section .,g~.,F~,,~, .......... Block ... ,.~ ......... Lot No..o.~/....~.../.~ // Building Inspector, Fee $..~.....~.~...~.. ~.... uulldlng m.~ector Rev. 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 (Building Inspector) APPLICATION FoF('BUILDING PERI'lIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Zone Ordlnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. applicant agrees to comply ~vith all applicable laws, ordinances, building code, housing code, an~_~gulations, and to t~a~ h iz inspectors on premises and in building for necessary ......... - :-' - ..... j~' f. appticant, ormam~ · (Mailing address of applicant) rate whether applicant is owner, lessee, agent, architect engineer, general contractor, electrician, plumber or builder. (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; .... ...... .... Location of land on which proposed work ~vilJ~be done.. ~.~.~..t~.~...C~.. ~--~.~ .~.-[. :.-- .............. ...... > House Number Street ~,~ Ha ~er "~ ! ~'t /r County Cax Map No. 1000 Section .... .~..~.~ ........ Block ..... ~. ........ Lot...[ .~. ............ 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..%~'~ ~P~-:-~ .~. 'l~r. · ..~9~/g~/~ ~d-~ 5,. · ~-~ ~r/~P~ ........... \, 3. Nature of work (check which applicable): New Building .... ., ..... 'Addition .......... Alteration .......... Repalr .............. RemOval .............. Demoliti~n ...... ./ ...... Other Work.. ,"~..~ .~..~ .~.... i ,9' (Description) g 'm t Cos c5~ c::~a~.,~ . , f 4. t st~ a ed t ...... 9 ...... : ........................ Fee....f.~.~.*,~. ...................... '... (to be paid on filing this application) 5. If dwal, ling, number of dwelling lunits ............... Number of dwalling units on each floor ................ If garaie, nu. mbeYf6f cars ......................................................... ;., ............. 6. If business, csmmercial or mixed occupancy, specify nature and extent of each type of use .,,~,;.~-,~e~ ........ 7. Dimensions of existing structur6s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of Stories ...................... Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10, Date of Purchase ............................ . ~,~me of~ormer Owner ............................. 11. Zone or use district in which premises are situated,. ,~,~,.f'~ ~- ~'~,-x,L~-~'~ .................................. 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ............. ~..~. ............ 13. Will lo't be regraded ...... ~ .............. .~..... Will excess fill be removed from premises: Yes ~ 14. NameofOwnerofpremises~ep~..-~.c~e~d,~..Address .~o'~9¢~.~..~ ..... Phone No. ~.O.O.-.~.&/2 ./~.. 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. FOLLOWING FOR POURED CONCRETE ~. ROUGH - FRA~T~ ~ ~t.~Bl~ 3. INSULATION 4, ~INAL - CON'STRUCTIO~ 'MU~T ~E COMPL. ETE FO~ ~LL CONSTRLJCTION SH~EL T~E ~EOU1REMENTS OF THE N. ~T~TE cCO~STR'UCTION & ENERGY QO~.E'S. NOT RESPONSIBLE F~ STATE OF NEW YORK, ' ~ ~ county OF ....... ...... ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) a'bove named. He is the .... ..................................................... ............ (Contractor, agent, corporate officer, etc.) of sa~d owlner or owners, and is dt/ly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~n~r set,forth in the application filed therewith. Sworn to before me this ............. .... da of .... .... Nota~ Public ........ . . f. County (Signature of applicant)