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Home My WebLink About13975-z I~OBI~ NO. II TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13975'Z Date Permission is hereby granted to: .~......ff. :~.~.....~.~ ....... ~..: ..... ~..~...~..7.~ ................................................ .......~.~....~.~_ ._. ....... J.....t~..~ at premises at ...~.~ ................... ~H' ....................................... '*~"* ............ ~'*'~ ............ .Y;.. .... ....................................... County Tax Map No. 1000 Section ....0....~....~...~'... ...... Block ......... ~. ......... Lot No .... ,.~...~..'/ 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 pproved .... .~.~t/,_~..Dr .~., 19~.~~. Permit No. !..~.~..-1..~...~ ~isapproved a/c ..................................... B .O~J. DEPT. TOWN OF SOUTHOLD Received ........... ,1 (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 Is 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- tion. 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 all be kept on the promises 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 all 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 Jilding 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. Ne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building fo~ necessary inspections. ...... ~-..~.c/./~, .~.o. ?. (q.. ~?.-.~?.e.'....Qo. (Signature of applicant, or name, if a corporation) .... .~. .~. .~. ?. . . .~./.?.&. ..... .~. .,r. .77z.~. .~. . ~. .< .~. /.¢..//.q (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder. k_ ~.~,c¢ .... c~'~'~4~/~ 'A' ........ AS' NOTED ' ane of owner of premises . &.' ~.~.. ~...~/.c. (c~ .... ~:~ f ~.C:2 .......... DAZE; (as on the tax roll or latest : . ~ BY: _~_.~.L, applicant is a corporation, signature of duly authorized officer, ....... '~ ' (Na~d and title of corporate officer) Builder's License No. __6-~) ~/ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... NOTI~' B~ II[DING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOL.L©~^d NG INSPECTIONS: 1. FOUk*r~ATION - TWO REQUIRED FOR Pr'lJRr43 CONCRETE 2. ROUGM - FRAMING & PLUMBING 3. INFU~ A'~fqN 4, FIMA~ ¢~N'c"RUCTION MUST BE C"~*r"'-rF FOR C O. ALL C~h'c'-R}!C~ON SHALL MEET THE REm''gr~'FNq'S OF THE N.Y. STATE CCNCrRUCTIO~ & ENERGY CODES. N~T RESPONSIBLE FOR Location of land on which proposed work will be done ..................... D~$1.GIg .0¢ .CONSTR.UCTI.QM .ERR09S. -'.~.~. ~ ~/~. ~ ~..~. ~ .~ ~ ................. ~,,S "Q: ....... - .............................. House Number Street Hamlet ,Z y'. / County Tax Map No. 1000Section .... ...~... ~.5.~... Block....~. ............. Lot.~.z ....... 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 .................................................................... ~ 'f/~ ' ppli ' ' 3. Natur 'o ~rk(¢heck which a cable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work..~. ~.~.~. ....... ' · ' (Description) 4. Est~a '. ...................... Fee. . ~ ~' (to be paid on filing this application) 5. If dwelling, number of dwell~ng~ units ............... Number of dwelling units on each floor ................ If garage, hum bet of cars ........................................................................ 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use .......... 7. D~ensions of existing strnctures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... HeiSt ...................... Number of Stories ...................... ' 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Fomer Owner ............................. 11. Zone or use dist~ct in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. N~e of Owner of premises ~:%. ~a~.~ ....... Address . 7~T .qq~( .~[ ...... Phone No.~72. ~J~Y~ ..... Nme of Architect ............................ Address . ~f~?~ ......... Phone No ................ Nme 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. STATE OF NEW YORK, COUNTY OF ......... ........ .S.S ............... .~../.~...~ff. .... 4."...~..~.?.~.c.W.~. (°. . . being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manndr set forth in the application filed therewith. Sworn to before me this ......... .c~ ..... , ........ dayof ............... 19 .~.~.'-' NOIARY PUBLIC, State of New Yoik ............ NO, 4707878, Suffolk Count~ Tert~ Expires Marct~ 30, 19~[-/7 (Signature of applicant)