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Home My WebLink About11544-z TOWN OF; S,gt~THQ~) TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIi (THIS PERMIT MUST BE KEPT ON THE PRE/~ COMPLETION OF THE WORK AUTHORIZED) No. 1,1544 Z Perrhission; is hereby granted to: is~s UNTIL ~ULL ,, ~: , , Iff' , ;:~ , ~ ~. .............. Co.~ty :TaX Mop No lO00 Sect on ........... ,. .......~ Bock '...~....';. ........ :~ot No ..... ,~,, Buil~lng~ I~spector. Fee ~.ff.;...;~.; ........ Rev. i6/30/~80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, lq.Y. 11971 TEL.: 765.1802 Di:ap~roved a/c ....... ; .'~ ........................ (BuiMing Inspector) APPLICATION FOR BUILDING PERMIT Application No ................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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 stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl cation. c. The work covered by this application may not be commenced before issnance of Building Permit. d. Upon apprc,'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pen shall be kept on the premises available for inspection throughout the work. e. No buildiag shall be occupied or used in whole or in part for any purpose whatever until a Certificate of O¢cupa~ shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zune Ordinance of the Town bf Southold, Suffolk County, New York, and other applicable Laws, Ordinances Rcgulations,'for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ, The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in bnildings for nAcessary inspections. ~- _ ~; (Signatureofaplicant, orname, ifacorporation):(S:~gT ~qT"h g-/'~t.oT~o~9~ ·. az:y<_ ........... /....: .......... '. )~(Mailing address of applicant) - State whether applicant ,s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Xa nc r r " ,..e llC Og £c: ICK:. , I/v' .................. o o e mir ............. ':...:-...' ....:'...? .... } ....; .................. (as on t ~e tax roll or latest deed) ir applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... /x/ ~ Plumber's License No. Electrician's License No.' ,/~/' ,C~ ' Other Trade's License No .................... Location of land on which proposed work will be done. .... /.: .... ~,&~.. .................................. .,- ...................................... House Number Street Hamlet County Tax blap No. 000 Section ... : .v. . Block ................ Lot ................. Subdivision ...... Filed Map No Lot (Name) State existing use and occupancy of premises and intended usc ami occupancy of proposed construction a. Existing use and occupancy /"40 ,V' ~ b. Intended use and occupancy ' ' Repair Reluo~' al Demolidon Other '~Vork ' ~ee~ ~ ~ (Descfiption~ If d .... rog, number o~ dwel ng units ............. Nmhber of dwelling units on each floor arage, numberofcars .~ .................. : ....................... :"r "' ................ If busmess, commercml or m~xed occupancy, specify n0tum and extent of each *ype of us~ ........... Dimensions of existing stmdmres if any: Front Rear ' : Depth Height Number of Stories ' Dimensions of same stmctu?e with alterations or additions: Front Rear Depth ................ 4 .....Height .............. ~5~ ;~ ~. Number of Stofies Dimensions of entire new construction: Front ~3.q.~... - ~ ~' . Rear...~ ..... ~.., ~ Depth ~:& ....... ~ ~ Number of Stories ' ' Iteight '. ' Si or: Front ...... . .......... ear ............ e ................ Date 6f Purchase N~me of Former Owner Zone district in whicl~ premises situated ~ ~ l ' Does proposedconstructionlviolateanyzoninglaw, ordiaanceorregnlatio'n; .........,......,,.,.........' Wi~ lot be regraded ..... i .... ' .................. Will excess fill be ~emoved from premises: Yes Name of Archi[~ct~eY~ ~/~A~ .... '.. Addres~L ~'. ~i ~ A~ Nt ~ Phon~ No.'(. Name of Contractor Address - Phone No PLOT DIAGRAM Locate clearly. ~d distinctb ~l m ildings, whether existing or proposed, and. indicate ~1' set-back d~ensions fr >mperty lines. Gi~e street and bi )ck number or description according to deed, and show street names' and indicato what: ~[crior or corner lot. 3TATEOFNEW~'~Kv:-r~ J ~' S.S "OU Y OF .,'~>. .'~. . . " .~'~ ...... . ...... being duly sworn, deposes' and sa>s' that he is' the applic ,(Nanie ofindMdual gning contract) '~bove named. e is the ~ (Contractor, agent , corpo rate'offic er, etc . ) . i ~r said owner or ownen, and ~s[dnly authorized to perform or have performed the said work and to m~e and file ')plicafion; that all statements cDntained in this application are true to the best of bis knowledge and belial; and that ,~rk will be performed in the m~nner set forth in ' ' ' the apphcatton filed therewith. worn to before me this .............. or... g.., otary Public ...... ~, ...... ~ ~.. ~/~.. County '-- " ~ ~OTARY P~B Q S~ate of N~W Yor~ ' ' ; -P' ' ' ' ' -" V .......... , / ~o. $2-812a850, 8u folk County '