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Home My WebLink About13834-z · OEM 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 ^UTHOP, IZED) N-° 13834 Z Date ..... ~...~ ........................ , Permission is hereby granted~to: , /~ ~ a~....~.....~.,. ......... ~..~. ........ o~....~...~.:.~.:.....u...~.R./. ........... ~ .~ ....... ...... at premises located at ...~...~.%~.....~ , ...... ..N~f.~.. ................... .... ~......a~.....~....~ ..................................................................................................... County Tax Map No. 1000 Section ..... ..(~.....~..~. ..... Block ......... J ............ Lot No ........,~.."~- ............ pursuant to application dated .... ~.......~. ....................... , 19..~.~..~*, and approved by the Building Inspector. ~ulldmg Inspector Rev. 6/30/80 AP?2C- _:) AS NOTIFY BUILDING DEPARTMENT AT 765-1~02 9 AM TO 4 PM FOR THE FOL. L O'¢/H'qG INSPECTIONS: 1. FOUNDATION ~ TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ]NcU[.AT~ON 4. FINAl... CONSTRUCTION MUST BE C¢~F~nLFTE FOR C.O. All COhmTR',JCTION SI IALL MEET TI ff~ RF~''PFMENTS OF THE N.Y. STATF CONqTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGN O~ CONSTRUCTION ) lo do the worl~ a~ t~p~cffmd, Paymept wdl/be jna~,q~e u~, oudmvd above 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined .Q~....a...'., 19 ~k"' Approved .... ,19 . ..Pe itNo.! Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 shall 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 shall 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 Building 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· The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · ~.~-.~.'~,,,k. ~x..'F,;,,~.~.-..~?,~.,-~..-, .-~...' ....... (Signature'crPapplicant, or na"rfie, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ~ ~ .-.~ c~-~.l....C.~.,.~.,:~.~c~..o. C ........................................................... Name of owner of premises ...... .~..'c,..g¢.o .t'.,~.e.~-...Q<l.% C.~ ......................................... ~3 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . ...... k,J ~ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other*Prade's License No...~. ~.~. ............. I. Location of land on which proposed work will be done .................................................. ...... · ....................... o.,..,,.,.~_,~ o .~ ~.~.~..~. ...... -O.~.~,, e.° ~'.~: .~ .~.'.Y.' .......... House Number ~-3 Street Hamlet ~ County Tax Map No. 1000 Section ..... ~ .3. ~ ..... Block ..... l ............ Lot .~.¢.~.. ~ ....... Subdivision ..................................... Filed Map No. ~ ~ ~ ....... Lot .... ~.~.( ....... (Name) ~'7, - I - ~' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~, ~xistin~ ~se a~d occupancy ...... ~ ¢~;,, I ~,. , co.o,~, ........................................ 10. 11. 12. 13. 14. 3. Nature of work (check which a~plicable): New Building ..... ' ......Addition. .......... Alteration ..... Repair .............. Removal .............. Demolition ............ Other Work .~ ~c..,~z. ..... ! ~q (Description) 4. Estimated C~)st . \ /D .kC'. \ o ........... : ......................... Fee ...................................... : ~'. (to be paid on filing this application) 5. If dwelling, number of dwellingmnits ............... Number of dwelling units on e~ch floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixeld 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 ............... Number of Stories ................................. Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... Dat of P ' r Own e urchase .......... ~ .................. Name of Forme er ............................ di iti wh' hpr~misesares't ated Zone or use str c n lc 1 u ..................................................... Does proposed construction vie!ate any zoning law, ordinance or regulation: ...lq m .......................... Will lot be regraded ....... ,;.r ' '~,' ' ' '.' · '3~ ....... Will excess fill be re$oved from premises: Yes No Name of Owner of premises .~ r. :~ .~, C.~..~1~¢/q. Address ~. ~*..~v~ ¢.~.~ ~.~r. Phone No. ~.2 ~/:. ~.~.~,q'~. Name of Architect ~_o. ~,~,~ ~ .GL~.~.o' I. (~ ........ Address~'~}9..L~,acd ~.e. ~'~,~v .~A°. ~t~o ne No. ~/~ ,5[--: 1 ,.-3.q ~ .... Name of Contractor~.~u r~r,.~i~c-~.q~,~. ~rv~$' Address . .': ..... '? ....... ?.. Phone No. "/t,~..: &.O .~.13. property lines. Give street and blocklnumber or interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from description according to deed, and show street names and indicate whether I 1 STATE OF NEW YORK, iS.S OUN~Y OF .............. above named. sworn, deposes and says that he is the applicant No. 4707B1~. Sulf01k C0~nt~ ,~ He is the ...................... i ................................................................... i (Contractor, agent, corporate officer, etc.) of saki 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 cont&ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannek set forth in the application filed therewith. Sworn to before me this i c~ ~ day ofl ~ . , 19J3.~. ........"7/., .-s/ ....... "'i''' 7'0'' ........... .... ......Oo n, HELEN K DE "/OE i ~"--, J~OIARY PUBLIC, State of New Yorl( ........ r'. ...... (Signature of applicant)