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Home My WebLink About11774-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N, Y. BUILDING PEP, Mir (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) N°. 11774 Permission is hereby granted to: ...... County Tax MQp No. 1000 Section ~...~.,..~. ....... Block ~...~. ........ Lot No ......~...~. ........ pu~uon, ,o o~l,~o,,o, do,o~ .a2~.../...¥. ............................... 1,.~'.~ ond op,~ b~ Building Inspector. Building Insl:~ector Rev. 6/30/80 5 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Approve 19~<~ermit No. [./ '*" '~ ..................................... ~!~h~.. .~ (Building Inspector) APPLICAIIO~ FO~ BUILDING PERMIT / .... 51.Z5 ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue a Building Permit to the applicant. Such permit shall 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 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, mad to admit authorized inspectors on premises and in buildings for necessary inspections. .., ........... (Signature of applicant, or name, if a corporation) · .' ?. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nme of owner of premises , .~..~.1.~ ~.~...~ ~~ ...... ~~,'. ,',: .%.~.' ..... . .......... ; (as on the t~B~;t~t d~.?. ~ / Y ~V:7 ~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...z~../.~..~- ................... Plumber's License No ......................... Electrician's License No ....................... HNOTIFY BUILDING D.E.P. AP.':F~F.~T.. ,A,T 7'7654802 9 AM TO.A PM F~R:'T,2.IE r' FOUL O\,V!N!G INSPFCTIO~S: '1. FOUNDATION - T,WCi.,I~EQ~UIRED :: 2, RCLIGH -,FJ~,~,iNG & PL,UMBING ~ 4. FINAL - CON'STRUCT!ON MUST BE CG,MPL~,TE FOR C ~. M o~ ;.; ALL CONSTF~UCT~ON ~HAL. L~ MEET Other Trade's License No "THE 'REQUIRE.ME~T~. o~F. T_H'~.' "",N.! Y. ...................... ',?"STATE CONSTR-Lc,.C..._T.(0N9' 'S'. 1. Location of land on which pro osed work will be done re, CODES..,. NOTi~, ~P~p.~s.,.~E~ '~; FOR -l~- ms~oN o~,,?c~.~l~,U¢~)i6,~ ERRORS · ...2. ~ M ................ W.+hW...u.~..~9.~.. ~.~ .~ .................... ............... House Number Stre~ Hamlet County Tax Map No. 1000 Section .~..~2,...¢ ......... Blodk ... ~.. ~ ......... Lot ..... ~-.~..¢ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~..~..e-..: , .~.... O~.....\ .~..\. .......................... b. Intended use and occupancy .......... ~.~..~.:'.;¢~:q,l~. ,..~.~,~','.~)}~!~.~'~.C'*, , ........................ 3. Natureofwork(checkwhicb applicable): New Building .: ........ Repair .............. Removal .............. Demolition 4. Estimated Cost.. Fee Addition .......... AlteratietnA. ......... ............ Other Work...-~r> ~-.~ .~>..~ (Description) **/~.- ~. ........ (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each flo~Sr ................ 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 strnctur~s, if any: Front .................. Rear .............. Depth ...... . ......... Nun~ber of Stories Height ....................................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i ·. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction; Front ............... Rear ............... Depth ............... Height ...... : ........ Number of Stories ........................................................ 9. Size of lot: Front .......... I:o. ~ ........ Rear ......... /?. P. ......... Depth ...~...~) ................ 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use &strict ~n which pr~m~ses are sxtuate ..................................................... 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. Name of Owner of premises ~...Q:., .~.. f.e-.~C~. Address (0: ~.~'1,.. (~r.~q'.. Phone No. Ova-5...,~ .~.~ .(q.. Name of Architect ......... ~... ............ l · Address .....: ............. Phone No ................ Name of Contractor ........ , ................. Address ................... Phone No ................ . i PLOT DIAGRAM .//' Locate clearly and distinctly all buildJ-ngs, whether existing or proposed, and~ indicate all set-back-dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or~-c°rner ........ 19_t_..___- ~j STATE OF NEWoYORK, - , COUNX¥ ..... i S.S ............ ~: .t..a~-..~.~..e~x9..e~. ................... being duly sworn, deposes and says that he is the applicant (Name of individual sigging contract) above named. He is the ..................... 0_,~.~.~ ...................................................... (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 tothe 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 ~, P, ublic, ..... ~.^'/~ · .~~. County /m Ho.. 5~-8125850, Suffolk r.,rn Ex~ir~! M,r.h ~0. I