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Home My WebLink About13923-zTOWN 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) NB 13923 Z Count7 Tax Map No. 1000 Section .... ...~,.,~...~. ..... Block ...... ..~...~. ........ Lot No ........"~,,.~ ........... Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~... ~ ...,19~.)~. Approved ..x~2¼ ., 19~.~.. Permit No.). .~..~..~.~.~. · Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Received ........... ,19... bA 7 Date ................... 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 lets of plans, accurate pict 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 Bhilding 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 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 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 regulations, 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 nece~ ins~oc~ti_ons~//~ (~, LC...42~..~..~.-r.~. . .5-.~ ·..i>-' 7 ...... ~ .......... (Signature of applicant, or name, if a corporation) (Mailing a~dress of applic/t~t) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ........................................................... , ............... Iame of owner of premises . .~..[ .~..~ .~.W'. g..4.-..~.~/. ,:~..~.~..-2-'~ .... . .~...,~?..~....~.t.'.,X..t3 .................. (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. '-~ ~ ~'q House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..~. ......... Block ....... I ........... 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 ,/ ~../~...~}./r.~ .~...t342~' i).,i.~..~' b. Intended use and occupancy ......................................................... 10. 11. 12. 13. 14. Nature of work (check which ~pplicable): New Building ..... ' .....'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ......... Other Work. ;:~.~. ~/¢, ~ .... '~ t~ i (Description) Estimated Cost..~..! .................................. Fee .................................. i ~' (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structu, res, if any: Front ............... Rear .............. Depth ............... Height ............... Nqmber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. i .... Height ...................... Number of Stories ...................... Dimensions of entire new comtruction' Front Rear Depth Height ............... NUmber of Stories ........................................................ Size of lot: Front ......... ' ............. Rear ...................... Depth ...................... Date of Purchase ! Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction v!olate any zoning law, ordinance or regulation: ................................ Will lot be regraded ....... ..................... Will excess fill be removed from premises: Yes No Name of Owner of premises . i ................... 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 fron~ property lines. Give street and block number or description according to deed, and show street names and indicate whether inte~or or corner lot. f AP?~,O'TXD AS NOTED DATE: B.P. :~ NO'I:IFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: l. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2.ROUGH - FRAMING & PLUMBING 3.INSULATION 4.FINAL - CONSTRUCTION MUST Ny BE CnMPLETE FOR C. O. c:"2')/'"' ALL CONSTRUCTION SHALL MEET '", THE REQUIREMENTS OF THE N. Y STATE OF NEW YORK, i S.S STATE CONSTRUCTION & ENERC'/ COUNTY OF ................. ~ CODES. NOT RESPONSIBLE ' being duly~, c~o~t~[~sTt~Da~ hEel~zsit~ applicant (Name of individual signing contract) above named. : He is the ..................... I .................................................................... i (Contractor, agent, corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work arid to make and file this application;that all statements conialned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ .... bi0 4707878, Suffol~ Cour~tv . (Signature o~ applicant) Term Expires March 30, 19~