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Home My WebLink About13971-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, No Yo BUILDING PEKMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 ~397~ Z Permission is hereby granted to: ~ t n **~*** .~.....~/~....~i~.~.......~..: ..... ..~.~....~..~.~ ................................................ ...~...o,.~.&,....~:~., ...... I..L~.~:~. ....~ .... ~... *~ ....... ~.. ~.~...~ ~ ~~' ........ ....... ..................................................................................................................... Coun~ Tax Map No. 1000 Section ..... /..~..~ ..... Bl~k ........ ~..I ....... Lot No ..... ~CI ............. pursuant to application dat~ ............. ~.~.J.~ .................... , 19~..~ and appmv~ by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 pproved . · .~'.*'..., 19i~.~. Permit No. ] ..~.~ .~.~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN Received ........... ,19... Date ................... 19... INSTRUCTIONS a. Tins 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 ;uilding 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 clmit authorized inspectors on premises and in building for necessa inspectio . (Signature of applicant, or name, if a corporation) .....~...~., .¢.~. ~~ ?..w..ff. :../.~..--~ (Mailing address of applicant) ~,tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~'<.~ .... ~._/~.....(]~ ~)'n' il~e' ia;(' ~o'li g; ia't~t' [1;if1) lame of owner of premises applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... . .c~..~..~. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ' ........ ....................... House Number Street -- -- Hamlet County Tax Map No. 1000 Section ....... /..~.? ...... Block .... / ............. Lot..'~.. f. ............. 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 .................................................................... 3. Nature ofwork~ (check which applicable): New Building ..... ' .....Addition i ......... Alteratio,~. _.. j ..... .Repair ............. Removal .............. Demolition ............. Other Work..~r~.r~... ..... ' .~..~..~.?! ¢t(.,~7 (Description) 4. Estimated Cost .~ Fee . ; ~' (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ! .................................................................... 6. If business, commarcial or mix{d occupancy, specify nature and extent of each type of use ..................... 7. 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 construction: Front ............... Rear ............... Depth ............... Height ............... Nmnber of Stories ........................................................ 9. Size o'flot: Front .......... ! ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 11. Zone or use district in which piemises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess filkbe removed from premises:Y~es No 14. Name of Owner of premises ~..,t~.,~Pr~g.~ ...... Address /2~. ~~' .~4/: Phone No. ~..~.'% ~..~..g.o~. Name of Architect ........ ' .................. w' Address ~?..~.'. Phone No .............. Name of Contractor ...... .......... Address ........ '....t/. ?~. Phone No PLOT DIAGRAM Locate clearly and distinctly ali 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. .} t,2 FEE:. % ..... BY: y'- NOTIFY BUILDING DEPARTMENT AT- 7~5 ;~°02 9 AM TO 4 PM FOR THE FOl..LOWING INSPECTIONS: 1. FOUNmATION - TWO REQUIRE~ FOR PmtJRCD CONCRETE 2. ROUGH ~ FRAMING & PLUMBIN~ 3. INrtJI STATE OF NEW YORK, [ S.S 4. FIN,' ~ C'3N'STRUCTION MUST COUNTY OF. ; ................. ~-r~d~ ~-i~i' B5 ~ '~'P' WTF FOR C. O. ~r~*~ being y , ~ ~,~~C~y. .... dul sworn de ALL aC~NST~',~C.'[ION .SHAL~. MEE% (Name of individual sig~ing contract) above named. ~TATF C~NcTRUCTION & ENERG~ . CODES. N~T RESPONSIBLE FO~ Heis the (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du)y authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the workiwfll be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this [lljfl~Y PuBI~I6 Sthte of New York (Signature of applicant) No, 4707878, ~of~o~k County.~ lorm Expires Mar? 3(), 19~/ '