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Home My WebLink About12311-zBUILDING DEPARTM~N~ TOWN H~LL~ SOUTHOLD, N. Y. N~ BUILDING PERMiT (THIS PERMIT MUST BE KEpT (~N THE PREMISES UNTiI~ ~ULL COMPLETION OF THE WORK ^UTHORIZED) Ig311 Z Permission is hereby granted to: .~.~..~ ...... ...~.,......~.,~.....~::.L.i: ...... ~ /'~', ,o ..~..cgz~.~....~.~,~..~..~m~...~,.~.. ..~... ~ ............ :~ ................ ~ ............. ~ .......................... ~ ~,., ~=.~ ~ ............. ~ ........... ................ ~ ............................................ ................................... ~...~,.....~ .........,....~ ......~ ......................... Coua~ r~ M,p Uo. 1000 S~ct~on ..... ~.~....L..'. *l~k .L..gZ ........... kot Uo. ~.~.~ .......... pure'ant [o application dat~ ...... ;......e.~.~..~:,......, 19. and approv~ by the Building I~spector. Fee ;..~.~.~ ............... nspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~..~...Z'( ..... , 19 ~.'.-~' Approved....~....~....~.d..., l~4Pe~it No ........ Disapproved a/c ........................... ..... ..... Application No..Jc~t2 .~(/~. ........ 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. .. ~ __ (Mailing address of applicant) State whether applicant is w~eri'-i~ agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises . . .t'~. ....... .t~..d..;~-.../~..~. ..... .~..~/./..e-~..C..~ .t~42> ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. : . .... p · (Name and title of corporate officer) ~(7~ ~ t'&~ /~ ~ Builder's License No .......................... "~'~' Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which~,proposed work will be done...~./.~', t ~ ~ ~'~O~ ~ ... ............... ................... House Number /r'~tiO0 [~t~.tt~/ ~'~e~ ~'~.e~}', Hamlet County Tax Map No. 1000 Section .................. ~ ................../[¥. 4=~ ................... [ Subdivision... X Filed Map No. ~¢ Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ) Nature of work (check which applicable) New Building .......... Addition .......... Alteration .... Repmr .............. Removal .............. DemohQon_. .............. Other Work...~. ~ .~. ~. .... ~st~at~d Cost ' - (to be p~d on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ............... If g~age, number of cars ..... ................................................................... 6. If business, commercial or mixed occupancy, specify nature ~d extent of each type of use ..................... 7. Dimensions of existing stmctum~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ep~ ...................... HeiSt ..... x ....... t ........ Number of Stories ...................... imensions of entire new constmction' Front ~ ~ ~ * Re.~ ~-~ ~eight ............... Number of Sto~es ...... [f~ (ff ( ~..~.~ ............................... 9. Size of lot: Front ........... ; ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ .................. Name of Fo~er Owner ............................. 1 I. Zone or use district in which premises am situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or mgulation: ................................ 13. Will lot be regraded .......... ; .......... · .~ ...... Will excess fill be ~moved from premises'. Yes No ~Name of Architect .......... : ......~q(~ddress ..... ~.Q~ Phone No ................ Nme of Contractor ~~.. ~ .~ .... Address ~: ~l~_'S~''' Phgne No ................ P~T DIAGRAM Locate clearly and distinctly all!buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF ~E~ r./3R~,.~ .~Z eS COUN l... .... ¢"t---~ f~q'~e-~f~ld~(i~' · ~ .... · .. being duly sworn, deposes ~d says that he is the applic~t above namea, He is the ............. ~.. .. ..................... -(Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authored to perfom or have peffo~ed the said work and to m~e ~d file this application; that dl statements contained ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~ner set fo~h in the application filed therewith. Sworn to before me this ............ ..... ...... ~ Public, . ..... ~ ...... ~.. County No. 5~rg]25850, Suffolk r.r.~ Ex~ires March 30, 1~