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Home My WebLink About14963-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,ou,,o.~.,.,. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14963 Z Permission is hereby granted to: ~.~~ ....... ~./~....~.~ ~~~/ ~....~..z~ .................................... ~.....~/.~r~,~,,,~ ~ ............... pursuant to application dated ........... ~ ........................ , 19.~1~., and approved by the Building Inspector. Rev. 6~30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~/.~.., 19~..~ ApprovedJ-~.. · ~.~. .... 19~. Permit No.~..~..~.~.~. ~ Disapproved a/c ..................................... Received.,~... APPLICATION FOR BUILDING PERMIT 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. e. 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 necessa~ ~?_ect~ons~,~ /// (Mailing address o[' applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax r~ll or latest deed) If applicant is a corporation, signature o f duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... · Plumber's License No ......................... Electrician s License No ....................... O~er Trade's License No ...................... ,. o tion on whi .,,o os , wor [-louse Nu~er Street Hamlet Co,n~ ~ ~a, ~o. ~000 S~tion .... !.'~ .......... ~oc~ .... ~ ............ Lot...t .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existin~ use and occupanc~ of premises and intended use and occupancy of proposed construction: ~. ~xi~n~,se ana o~,pan~. ~.~[~ ~t. b. Intended use and occupanc, ,.~("~.A.~m.*~. ' 3. Nature of work (check which applicable): New Building ~Addition .......... Alteration .......... Repair .............. Removal .............. D6molitibn .............. Other Work ............... ~o .~. (Description) 4. Estimated Cost~..7- ~. {2 {)....~.:. ...................... Fee .. .0"7.~: ~'..~. ....................... *-- (to be paid on ~ing this application) 5. If dwelling, number of dwelli_~units ............... Number of dwelling units on each floor ................ If garage, number of cars ..."] ~ ..................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .~,~ ............ Rear .............. Depth ............... Height ............... Number of Stories..(-~d...'~... ...... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ., .......... Number pf Stories ........ ~ ........ 8. Dimensions of entire new construction: Fr;~t' i i i.~ .~ ........ Rear 22 Depth Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ............................. :~ ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~..~. ..................... 13. Will lot be regraded ....... , ......... ~..,., ....... Will exc.e.ss fill~he removed from premises: Yes No 14. Name of Owner of premises A'~/g{l~.t.~.. ;~'g;.X .... Address J.~~.$/'/(Phone Name of Architect ...,m//7 F" '~'~' .jg,,~ ~; '2'~zd · Address Name of Contractor. t/te;-~,~.C::~, 1..~<..'..~". ~'.q. Address" ~'~.' ~ >i ii i i' Phone No ............. 2" ........ Phone No~.¢'-/~. :7??..7..~m 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, , S S ..... ~?- -~. ~<;e:Y ."7 bZ4~--~ .............. being duly sworn, deposes and says that he is the applicant (Name of individuai 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 manner set forth in the application filed therewith. Sworn to before me this ~0. sa-~6zl~a0 - $0 .n3},u~ q~_ ~m'¢ (Signature of applicant) I;{~MMISSION EXPIRES ~ Il'&"., 10' 2.0 ' ~65-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: - ~-~RED 2. ROUGH - FRAMING & PLUMBING ~. INSU~T~ON 4. FINAL - CON'STRUCTION MUST BE CO,MPLETE FOR C, O, ALL CONSTRUCTION SHALL THE REQU}R~M~NTS OF THE N, Y. STATE CONSTRUCTION & ENERGy CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION 'I I ULI']. t'40 J'z:c:),:lTi i