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Home My WebLink About12761-z FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12'/$1 Z Dat....~.~~......~./ ............ , ........ ~....:~...:l ..... t~ ~..~ ............................................................................ County Tax Map No. 1000 Section ....... ..~...~...~.~. ..... Block ........ ~..t}. ........ Lot No .......... 3. ............ pursuant to application dated ...~...~~....~ ................... , 19.~.~:% and approved by the Building Inspector. Rev, ~/30/80 Examined .~.~..~0'..i~.j. Approved ~)..~ ....... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 ., 19 ~.~ ., 19 ~. Permit No/.~..~ .~./..~ ' Received ......... , ... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..... l~ovorabev. 7' ', 19 8'3 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 plm~ to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to ~[djoining 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, ho.usj,ng code,,an, d, regulations, and to admit authorized inspectors on premises and m building for necessary inspections. /,/~ J///, /J (/I . / ... ~.. ~: ~...-~....~...~'...~....~ 5..'~...~. ....... (Signature oJ' applicant, or name, if a corporation) ·..~.~..7... ~d~ o~...Y.r...g.e. &.dr ~.~.... (Mailing address of applicant) ~o/.. _ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plum~er or builder. Regal. Pence Co 34.7. Wal.do Sgveet Cop. iague Cont~aegor Name of owner of premises . ...N.O.W...Yp.r.k.. T.o.l.e.p .l~9.n.o.. ~9.. ............................................. (as on the tax roll or latest deed) If applicant is a cor:porgl>ij0n, signature,of ~l~ly authorized officer. ....... :/: ~.,,'~ ..... ./.... ?., ..... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No...1.994~..g~f;t'o. lk .... l. Location of land on which proposed work will be done. YlqO~'.e.~ · b.a~e.. ~..i~o. hl.t.e..~5 ...................... .................... ; ..................... Gr. eenpo.~.t ........................................ House Number Street Hamlet County Tax Map No. 1000 Section ....045 ........... Block .. k .............. 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 ...~.12~'~ ~k~.~. !./0..}7....6(..~. ~ ....... ~ ~...~.~..~C~.~ ~. ........... b. Intended use and occupancy ...~.~ .A~...~...~,.d/. ~ :.~..*....~ ./~.,~..d.~... ~/~tg(.d..'.~.~.'~. · ........ 3. Nature of work (check which a Repair .............. Ren 4. Estimated Cost ....... 5. If dwelling, number of dwellin If garage, number of cars ... 6. If business, commercial or mix 7. Dimensions o f existing structm Height ............... Nm DimenSions of same structure Depth. ................... 8. Dimensions of entire new consl Height ............... Nm )plicable): New Building .......... Addition .......... Alteratio . .. oval .............. Demolition .............. Other Work .~::~. · .~.. i (Description) i (to be paid on filing this application) units ............... Number of dwelling units on each floor ............... ¢ o. ccupancy, specify nature and extent of each type of use ................... ;,s, af any: Front ............... Rear .......... Depth ............. ~ber of Stories ...................................................... ,ith alterations or additions: Front ............ Rear ................ .i.. Height ...................... Number of Stories .................... ruction: Front ............... Rear ............... Depth ............. abet of Stories ....................................................... 9. Size of lot: Front ............ ... ..... ... Rear ...................... Depth ................... . . 10. Date of Purchase ....... j ................. Name of Former Owner .......................... 11. Zone or use district in which ~mises are situated ..................................................... 12. Does proposed construction vi( late any zoning law, ordinance or regulation: .......................... '. .... 13. Will lot be r~gi'hd~d .......... ................... 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 ................ Locate clearly and distinctly ~ property lines. Give street and bloc interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether hFr HttH STATE OF NEW YORK, COUNTY OF~ ~..~/] ....... ....... ~/. '~.../4t~...~... ~..~. ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) t [' above named. He is the ............ ~ ........... (Contractor, agent,.corporate officer, etc.) of said owner or owner~, and is dub 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 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 .............. -- _ .......... , Notary Public~....~.'. ~ ............ County .~/,/~/~ ~o.i.,,,,,,. ,.~,,,. ~,,,, ~o, ~ (Signature of applicant)