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Home My WebLink About11796-zSOUTHOLD, N~ Y.: (THIS PERM T MUST BE KEPT Oil T~H,E PREgI$~S UNTIL F~ULL COM~r,o~ o~ TilE WOR~ ^UT~Ri~E~i i ~ ~1796 Z ~te ...... ~...{,.?: ........... .~:,~,..:..z...., ,9.~ at. pi'e ) located at .. ~ ~/7~_~ · ,~: ,-; ' ~," ' ~," e -~ County T~X Map No, 1000 Section ........ ':'"1_ Io~.~ { ,~.~.. ....... ~L°t No. "t ..................... pumUant to apphcat~on ~dated ........................., ........ ~ ..;...~ ~nd pprov~ by the Bijjl~tlng I~$pector. F~e ........................ Rev., 6/30Z80 : FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N,Y, 11971 TEL,; 76D1802 H.,. t "/ J' / .. Disapproved a/c .... ~ ' ' L.L~' ' ' ................. ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 laybut of property must be drawn on the diagram which is part of this apr. cation. c. The work covered by this application may not be commenced before issuance 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 building sbalI be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for th~ issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations~ or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, honsing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or na~rfe, if a corporation) (Mailing address of applicant) State whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build. dO tf T~/a4 e. T~ /Z Nmne of owner of premises (as on the tax roll or latest deed~ If applicant is a corporation, signature of duly authorized officer. .... ...... (Name and title of corporate officer) Builder's License No ..... Plumber's License No ......................... Elactrician's License No.' ...................... Other Trade's License No ...................... I. Location of land on which proposed work will be done. .............. U.O. ? ....g ....... v House Number ~7~ Street ~' '~ ....... ~[~1;~ '~~W~ ...... County Tax Map No. I000 Section 0~¢ Block ~.~ Lot Subdivision ~ ~ Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intended use and odcupancy of proposed construction: a. Existinguseandoccupancy . ~&~ S ~o ~ lrz~ ~ b Intended use and rn ,, , - occupancy ............................. .................................. ;.. ,~. 5. Nature of work (check whict, a'pplicable): New Building .......... Addition .......... Alteration .......... Repair Renio~ al' Demolition Other Work (Description). Estimated Cost .................................... Fee .................. ~ .......... (to be paid on filing this application) ;. If dwelling, number of dwellin~ units .............. Number of dwelling units on each floor ........ ; ....... If garage, number of cars ........................................................................ L If business, ~o nmercml or m~xed occupancy, specify fiature and extent of ~ach typo of use ....... ~4~ff~ ...... ~. Dimensions of existing stmctu?es, if any: Front .......... Rear .............. Depth ............... Heigh.t., .............. Number of Stories ........................................................ Dimensions of saine structure with alterations or additions: Front ................. Rear ... Depth ' Height Number of Stories ~. Dimensions of entire new construction: Front Rear Depth Height ............... Number of Stories ............................................ } Size orlot: Front ...... ~ ~ Rear .............. Depth .............. ). Date df Purchase .......... ~ ................... Name ~m~er Owner ......... ~ ....... 1. Zone. or use district n which Pre nises are situated .......... ~ ..... ~ ...... 2. Does proposed construction violate any zoning law, ordinance or regnlation: ...~ ......................... 1. Will lot be regraded ........ :..' .................. Will excess fill be removed from premises: Yes No [. Name of Owner of premises ~(~4..~.~ ~ .... Address ~PUP~ FJ~ . &~U?~'?,~ Phone No. ~.~7:. ~4~Z .... Name of Architect ' Address Phone No Name of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly ~d distinctly ~1 buildings, whether existing or proposed, and. indicate ~I set-back d~ensions from roperty ~nes. Give street and bloc~ number or description according to deed, and sh~w street names and indicate whether ,tefior or corner lot. / rATE OF NEW~R~/ . d S S ' ~ove named. : (Co agent, corpo~ ............... ~ said owner or owners, and is duly~zed~rform or have performed the smd work and to m~e and file >plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the mannbr set forth h~ the application filed therewith. ·om to before me this ................. '~~ ~ > , ~ ~ ~ ~ ' ~. ~.81258s0 SO~k Cm~., ' ' (Signature ofan~]ieanTh