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Home My WebLink About12662-z lZOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTJ~ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 0E KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to:,, , ~ .... ........ ...... ...~..~.~..~ ...... ~ ................. ~~~.....~.:..~.,...~..~.~..~.~.~ , ,o..~...~....~.~......~...~...~..~ ....... ~ .......... at premises located at ....~...~..,~.......~......~...~. ............ ..~..~ .......... cou.w Tax ~op ~o. ~000 Sect,on .......... .9..~ ..... ~loc~ ......... 1 ............ ,at ~o ...... i~ ........ pursuant to application dated ....~~.~.~......~....b......, 19~.~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined...~.../ ....... 19 ~{~ Approved .. l~-.c~.... J ..... , 19 .~. Permit No.J.~.te.~ ..... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ..~. ................ ,19(~C'~. .. 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 ~nspectors on premises and in building for necessary ins ections. -,. · . . ! ..... ~'~n~'~rna~m f~ o~r~'~'' . (Signature of app ' , ~,~I..%¢orp ' (Mailing address of applicant)/~/~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pl or b ilder. .................. ......... .... f,, ...................................... Name of owner of premises..~' ..Q .( .~. ~... ~. //~ ~ff.%(.a~.c n~th.e· t.a.x..(~.r6,1i o' l~t~ ......................... If applicant is a corporation, signature of duly authorized officer. ,..~ ~--~-'T''~ ~ ~ I~ -' ' ' .... .... ............ '~' c (Name and title of corporate officer) Builder's License No .......................... Plumber s L~cense No ......................... Electrician's License No ....................... 1. Location ofland on which proposed w kwilllbedone..,,~...?~.. .... ff~/(. ~.t ~/. ~ House Number 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration , ....... Repair . Removal ........ Demolition ........... Other Work ~(~cgtgd~ '~'.~. J'Z~. ~ ~ (Description) 4. Estimated Cost ........ f~C~)0 Fee.. J..... ~- (to be paid on filing this application) 5. If dwelling, number of dwelling 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 ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new¢onstruction: Front ............... Rear ............. Depth ............... Height ...... (e. '.[.%..~.~. Number of Stories ................................. 9. Size of lot: Front ...................... Rear ...................... Depth ....................... 10. zD;tneeOofrPu~recdh~s~ ~.a~_,~.r~.er Owner. .. 11. ict in which premises are situated 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 .................... Address ................... Phone No ................. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 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. ,:~ ,'c. ~ , ' ~ STATE OF NEW~"~, ../. //,d SS ~~'. .~.'~. ~ sworn, ....... c...~...r~ · . being duly deposes and says e is the ap?cant above named. ~le is the .2 ............................................................................ (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 o~t,~r' ~knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. 'T'r'~ Swo. m to before me this O'~-~-., , . . .. i ......... ~~ .day of...~ ·., 19~...~''~/- Not~w~Public ..... .'~...wn-~ .... ~-~~unty ,~, , ...._. , . , , v~ ~'-JI~I~'Y PUBLIC, StYe of ~ew ¥~r, . , .,( /(ffi~nature ofapplic~gnt)