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HomeMy WebLinkAbout13961-z ~Olt~ NO. S TOW'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERARIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- ~396~ Z Dote Permission is hereby granted ....... ~<~~ ......... ,.y..,...~x~.~../..~.. ,o ...~.....~......~..~.~.......~..,~....d~...~..~.....~. ................... ~ premises I~ated at ...J..~.~ .............. ~.~......~ ...... ~..~ ................ County Tax Map No. 1000 Section ...... /...?~..,,.,~,., .... Block ..... .~.....2... ...... Lot No ......,,C~.,. ............... ~ur, uon, ,o o,p,,co,,on do,~ ........ ...~.~..~.~ .................... .1,.t.~. ond opprov~ ~y 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 ., ., 19<~(. Permit No. )..~.~. ~!. ·~.· Disapproved a/c ..................................... BLDG. DEPT, TOWN OF SOUTHOLD Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... 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 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 necessary ' s~tions. , ,q /) ~ (Signature of applicant, or name, if a corporation) .... (Mailing address of applicant) ~ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ~ ~ ~' '~' '~-~' ................................................ '~,' ' ' .... :5 'ti~;' ~lOt~b' ...... ~qame of owner o f premises .. ~/..k.Z./..~r~..~/. .2~....~..~...7'~./..~. ~ ....... ~5~TdE~ ff/a.r]~S'' B :P. '~' '/~.~l/-o/~'.'. (as on the ta roll or laf'dst 'eu) · ~ "' If applicant is a corporation, signature of duly authorized officer. ~qO'~IFY B(]iJ~'~I'I'4G DEPARTMENT AT ~65-t80~ ~) AM TO 4 PM FOR THE FOLIDWING IN.~PECTION~: 1. FO/,INmATJON - TWO REQUIRED FOR Pr~tJ~r'"D CONC[~ETE 2. ROUGH - FRAMING & PLUMBING 3. INCUI A-r!c~N 4. FIN^~ _ r-v~)krSTRUC¥1ON MUST B5 ¢ ....... ~1 ~--~'~: FOP. C. O. ALL C??~:!~ 'CrtON SHALL MEET THE RF .... r,; V~NTS OF THE N.Y. Other Trade's License No ...................... ,~'T.A-rE CONSTRUCTION & ENERGY CO~E$. N-~,T RESPONSIBLE FOR 1. Loc~tion o£ land on which proposed work wiIi be done .................. DESIGN. OR. G©NS'FR~ .C';FION. ERROR. S. · ...../.¢./. 4.o ........... ............. ................. House Number Street Hamlet County Tax Map No. 1000 Section ~..~..~-9,.'Z.*."7..~. ..... 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 ............ O. rnt4~.. ~ :~~ .............................. b. Intended use and occupancy ....................................................... Nature of work (check which h~plicable): New Building ..... ' ..... Addition .......... Alteration . .' ........ Repair ...... · . Rembval ...... Demolition ............ Other Work ,~d/fl/g/, Estimated Cost . . .~z~ o..'7:~, ' . . Fee ............. : ~' (to be paid on filing this application) If dwelling, number of dwellin~ 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. : Depth ............ ,... Height .... Number of Stories 8. Dimensions of entire new conslruction Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ' Rear Depth Date of Purchase ~ Name of Former Owner ~ ZoneI or use district in which p~emises are situated ................................................. Does:proposed construction violate any zoning law ordinance or regulation: Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No Name of Owner of premises ~ Address Phone No Name of Architect ' Address Phone No Name of Contractor ....... : .................. Address ................... Phone No ................ PLOT DIAGRAM -1 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 13. 14. interior or corner lot. STATE OF NEW YORK, COUNTY OF ................ , S.S (Name of individual Sigrning contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... ~ .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ddly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann?r set forth in the application filed therewith. Sworn to before me this ............. ?..ofi:~.,. County HELEN K, NOTARY PUBLIC, State of New Yo'rk . No. 4707878, Suffolk Count~ ] ~erm Expires March 30, 1~ ~ ,, S~UND . Nio1¢ SURVEY FOR MILL/CENT B. TUTHIL AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: I"= 40' APRIL 15, 1974 ~ F~.-B. 4, ID 75 .~PR/L 29,198/ REFERENCE/ GUARANTEED TO~ CHICAGO r/rL£ INSURANCE COMPANY M/LC/CENT B. TUTHILL