HomeMy WebLinkAbout13929-z lrOR~ 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)
N9 13929 Z
Permission is hereby granted to:
.........
co..~ Tox M°p ,o. ,ooo s.,,,o.../..~.Z ........ ,~ ..... ~ ............ ~., ~.....~ ......
Building Inspector,
Fee $ ..............
Rev. 6/30/80
FIELD INSFECTION
FOUNDATION
(1st)
COMHENTS
FOUNDATION
2.
ROUGH FRAME &
FLUMBING
(2nd)
INSULATION PER N.
STATE ENERGY
RODE
FINAL
ADDITIONAL COMMENTS:
' FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-180;~
^ppro~ed®'5~....:...., l~:. ee~mit No./?. ~.. ?->~
)isapproved 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
~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-
: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 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
~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 necessarEjnspections.
.:..' .....................
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
lame of owner of premises '..~...O~.~...~.~...~.O,.g~.~.~. ~..~.1~?-.~...o.~. ..............................
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No... ,/'d~..~. ............
Plumber's License No .........................
Electrician s License No .......................
Other Trade's License No ......................
· Location of land on which proposed work will be done ....... .~.~.~.1~. ..... b.o.~.3[ .~. ~.'~...T.i' .~..K..0..~.. .........
...... .....
.................... Hamlet
House Number Street
County Tax Map No. 1000 Section ]~3 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 ...... . ~..t~.'.O. '.~.'.~ .T.t.' ~ ............................................
3. Nature of work (check which applicable) New Building ..... ' ..... Addition .......... Alteration
Repair .............. ReThoval ............ Demolition ...... 5{. ....... Other Work ...............
. I -7~ (D ripti )
4. Estimated Cost ............ : ................... Fee ...................................
' ~' (to be paid on filing 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 mix!ed occupancy, specify nature and extent of each type of use ..............
7. Dimensions of_e~isti~gst, ructu~es, ifany Front... I I' ' '' Rear . {. ~ ' Depth
Height .... ]..'~..~ ...... Number of Stories i ?'~ .... .. ' ............. . .
Dimensions of same structure With alterations or additions: Front ................. Rear ..................
Depth i Height Number of Stories
8. Dimensions of entire new comtruction: Front ............... Rear ............... Depth ...............
Height ............... Nulmber of Stories ............... ~ ........................................
9. Size of lot: Front ......... , ............ Rear ...................... ._Depth .... , ...................
10. Date of Purchase ~O-~1 .'~ ' Name of Former Ownerr~{..
1 1. Zone or use district in which p. remises are situated .....................................................
12. Does proposed construction viblate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ... J~. ............... t ........ Will excess fill be r~noved, from premises: Yes
14. Name of Owner of premises .."~*~tC.J.O~
Name of Architect I 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 bloc
interior or corner lot.
number or description according to deed, and show street names and indicate whether
STATE OF NEW YORK, ! S.S
COUNTY OF ................. :
............................ ' ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual sighing contract)
above named.
He is the ..................... ~ ....................................................................
' ~ (Contractor, agent, corporate officer, etc.)
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 conlained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manlaer set forth in the application filed therewith.
Sworn to before me this
Notary Pub '.
County
;,~--.v ' HELEN K. DE VOE
NOTARY PUBLIO, S a a al New '(orR, ' .................
x No. 4707878. Suit011/O0unI9 (Signature of applicant)
· 'ret.m Expires March 30. 19 ,~-7
F?.O. TUTHILL
~APPc,.L DNIA KIRCHGESSN£R
MAY FI'FUCK
LAND
N,Y. 3. LIC. ,'tO,
!1