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Home My WebLink About13978-zTOWN OF $OUTHOLD 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 13978 Z Permission is hereby granted to: C/-,~ ' ' · ...,.,--...-./.~: .... x, ..................... ,, .......................... ;. ~ ........ · ........... .................... ................................................. ~t-:'~' '""~'~-~: ............................................................... .~_/~-~ ........................... at premises located at .~..~..~.~.......~......~...u~.......~.....~..~.....~.....c~....~..........~........~...~ ............ County Tax Map No. 1000 Section ...... /...~...~. ...... Block......................C)q Lot No ...... L...~.. ............ ,o application dated ........... ......~.......~.~.'~T.. ............... ,10..~...~..'~, and approved by the pursuant Building Inspector. Building Inspector Rev. 6/30/80 · , 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 afeas, 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 trail 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 ~t 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 authorizedJnspectors on premises and ~ building for necessary~ ~' -- ~,- "~/~/} ," ~inspecti°ns' (,~j~_~ (Signature of applicant, or name, if a corporation) , ' /O. F' ('Mailing address of appticant) ~tate whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. lameofownerofpremises .... ..~./.'~.'.~.'~i~.'~ .~.'~j'' ~/J~ '~-~':~ .... ' ............ (as on the tax roll or lates~lecd) ~ AS NO?I:D applicant is a corporation, signature of duly authorized officer. DATE: ~.j~__/Tg _EP. ............................................. F[~_~._,.-~Z. 8¥: _~, 6', ]- , (Name and title of corporate officer) NOTIFY ~UII.DING DEPARTMENT A'F 76%1802 9 AM TO 4 PM FOR THE Builder's License No .......................... ¢OLLO'>,dNG Nc?ECTIONS: I. FOUNDATION - TWO REQUIRED Plmnber's License No ......................... FOR POUR:O CONCRETE 2. ROUG/4 - FRAMING & PLUMBING Electrician's License No ....................... 3~ INqUL.A¥[©N , 4. 4[~¢5~:DEll''^ ' ~'mr-~N'~Tr''[JCTION- F. ~OR C O MUST Other Trade s License No ................... 715 ,, ~ ~ ~ I' ' ' At~fJ',¢5' ':~' ON Loeation of land on which proposed work will be done..O,.¢,f.C~. ..... ~m ~¢~.~r.s.~..k~:..r~.. ~..:. .--. ~/ .~ ~ . ] CTA"~ ~ -TRUCTION & ENERGY House Number ~)3r ~ q.~_) Street ~,E$1C~iIt~fiCi~ONS~p,U~TION Count~ Tax ~ap No. 1000 Section .../Q.~..O.0 ...... Block .O.~.~D ........ Lot O/~ CY © @ Subdivision ' Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use a,n,d occupa~o~e~nstruction: a. Existing use and occupancy ..... //'~L,(-..~. ~.. .... b. Intended use and occuPanc ........... .~¢...~.~. ..... 4~..~.17: .l~..~..~.,*,..~y .t?,~. ,;,?:-.. Lr~¢? ............... apphcable): New Building .......... Addition .......... Alteration .. ,,.: ..... 3. Nature of work (check which ' ' ~:~ ~ ~ ......... Removal .............. Demolition .............. Other Work..~'7 C ~.... (Description) 4. Estimated Cost ff.,~ C!~, 5. If dwelling, number of dwellin$ units . If garage, number of cars .... , ...... (to be paid on filing this application) ......... Number of dwelling units on each floor ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctm*es, if any: Front ............... Rear .............. Depth ............... Height ............... Nmnber of Stories ....................................................... Dimensions of same structure Oith alterations or additions: Front ../.(I.C) ..... .. Rear ...~..~.' ........... Depth ..... ~.~O. .......... i..' Height ....... ............... Number p,f Sl:ories ~ ..................... 8. Dimensions of entire new construction: Front ... ~./~C~.. Rear ... ~..,,,e~ Depth ............... Height ................ Nu~nber of Stories ........................................................ 9. Sizeoflot: Front ........ ,~ ,.I, .~ ......... Rear ...................... Denth ......... ,.... .......... 10. Date of Purchase .../..~,~--J. ~../. ~ ..-~. .......... Name of Former Owner ..~../."X2~..~.~..~0~ .Z~/_.~O q I I.Zone'or use district in which premises are situated., i .................................................. 12. Does proposed construction viblate any zoning law, ordinance or regulation: ...F).~ ........................ 13. Will lot be regraded ........ ! ..... ~ ............. Will excess fill be rerrioved from premises: Y~es No 14. Nam~ of Owner of premises . .i~_~..z'-,,7. 1 ~q~ ...... Address .~./... ~ .o.~q ~C../&~. Phone No. ~.a°./...~. ~.d~.'F. Name of Architect ......... J .................. Address .. ~-.--e~ ff. ~ff-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 block number or description according to deed, and show street names and indicate whether interior or corner lot. CO£rT f O/ ooO STATE OF NEW YORK. , i ~ ~ (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant (Signature of applicant) He is the ........... : .................. (Contractor, agent, corporate officer, etc.) o ' ' - , 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 mariner set forth in the application filed therewith. Sworn to before me this .......... O~t'/7 . . ......... 19 ~...~ ?f.. Notary Public,~~. ...... County ........