The URL can be used to link to this page

Home My WebLink About12759-z lrO~J! NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLET'IO~N OF THE WORK AUTHORIZED) C~n~ Tox Mop No. I000 ~,ion ...... ~.~...~ ...... B,=k ...... ...--l. ........... ~ No....~...~ ........... pursuont ,o opplicotion doted ...~.~.~....CJ. ................. , 19.~L,, °nd opproved by the Building Inspector. Fee $.1...~.....~ ............. Rev. 6/30/80 FORM NO. 1 TCWN ©F SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .~... ,~....~., .2...0.. 19q.~. Permit No.}..~..'[ .~.::~. Disapproved a/c ....... ; ............................ .. Application No ................ (Building Inspector) APPLICATION 'FOR BUILDING PERMIT Date . .//./~. .......... , 19~.-3 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,iaccurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining promises or public stre¢ or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this apl: cation. c. Tile work covered by this application may uot 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 peru shall be kept on the premises available for inspection throughout the work. e. No buildhlg shall be oc~upmd or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by theBuilding Inspector. APPLICATION IS HEREBiY IvlADE to the Building Department for the issuance ora Building Permit pursuant to t Buildiog Zone Ordinance of tl~¢ 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 !~ compl~t with all applicable laws, ordinances, building code, housing code,~tnd regulations, and admit authorized inspccto rs onp re la is es and in buildings for necessa~~~ · - ......... .... . .. : ( ig att re of applicant, or name, if a corporation) e .o (?.:., .......... ' (Mailing address of aPplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ....0., .w. oc. .............. Nmne of owner of premises .... ~.ltI d.. ~..,..~.e.J[~/ .............................................. (as on the tax roll or latest deed) If applicant is a corporation, sigi~ature of duly anthorized officer. (Name and title of corporate officer) Builder's License No... ~..~"' · Plu nber's License No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ House Number Street Hamlet County Tax Map No. !000 Sectiot~,,~..~.'~.~ ....... Block ....... .~ ......... Lot ..... ¢.6. ........ Subdivision .~..~f,~ ........... Filed Map No. .~.~.~_'~.~ Lot ..~t,.~.. ' (Name) ................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .. b. Intended use and. occupancy ............................... 3. Nature of work (check which applicable): New Building .......... Addition .... , ..... Alteration .......... Repair .............. Removal .............. D~;molition ............ )~. Other Work. [~-.~-.~ C,~ ....... .~.0 ~/.1~. (Description) Estimated Cost .......... Fee . ¢ ........ (to be paid on filing this application) ;. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ ;. If business, commercial or mixed occupancy, specify fiature and extent of each Wpe of' use ..................... t. Dimensions of existing structures, it' any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories . ~ ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... ~. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............................... ' ......................... L Size oflot: Front ............ .'... ........ Rear ...................... Depth ..................... ). Date 6fPurchase ............................. Name of Former Owner ............................. I. Zone or use district in which premises are situated ....... ............................ ' .................. -). Does proposed construction violate any zoning law, ordinance or regulation: .//.0. ............................ ~. Wiil lot be regraded . .~0.. ..... ' .................. Will excess fill be removed from premises: ~//~es No *. Na,ne of Owner of premises .~l~t~-.~.~",~. .... Address .'~.0t'/~v~/~hone No..'~.~,e'r~4t/.~. .... Name of Architect ......................... ... Address ................... Phone No ................ Name of Contractor ...~}{O~. ................ Address ................... Phone No ................ PLOT DIAG RAaM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF NEWz~O, RK., a ,~ . g ..............' : OU~Y OF~...._ ~5~ .. ~~~ ................. being duly sworn, deposes and say~ that he is the applicant c ~Nanie of indMdual signing contract) ~ove named. is the .......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of iris knowledge and belief; and. J~t the · ork will be performed in the manner set forth hi the application filed therewith. . 'O~:',',;C;.--::.~ ............. V~-'- _.~,--~'~-Z~/ Notary Public, S','ate of ,Ne~' York No. 52-0344963 Suffo,k County/~,,...-.~' ,, r o . . ~ .,.¢"-...,..,~T,,~.. · .""~"q'~ .......... ; ........ Oommir~ion Expires Mari:h 30, 19dg-~ ' (Signature of applicant)