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Home My WebLink About12511-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12511 Z Date ....................... Permission is hereby granted to: /. ~ ~ .,, ~ ..................... ~...%.......F.. ........................................... ~ ............. ~.?.:.. ~......v...tLz ....................... ....... ~:":, ~ "'t ~ ~'~ l at preraise$ Iocoted at ........ ~ ................................................................................................................ County Tax Map No. 1000 Section ......... ..~.....~...... Block // Lot No. ~' and approvc~l by the pursuant to application dated ............................ ~ ...... ...?.., 19..........~..~...., Building Inspector. Fee / - ~'~ Building Inspector Rev. 6/30/80 Examined ......... /_ .Trr..., 19... Approved ........ .~./2: ~..., 19 .~ermit No. · ·/.~. -: .'r--~-(/~'''''- Disapproved a/c ..........~. ......................... ,-,, , ,-k.,AT ON FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Application No..../.~...~..(/ ...... 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 necess~.z~~~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ............................................... ................................ ' Name of owner of premises .... qT. · :? .t°??.~ .~. · · Z~/~. · .~..144.J.~- - -T-~ ............................. (as on the tax roll or latest deed) If applican!~s a corporation, signature of duly authorized officer. Builder's License No .......................... Plumber's License No ......................... Electrician's LicenseNo ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... .... .......................... Itouse Number Street Hamlet County Tax Map No. 1000 Section_. .... ?tC~..ff..& .......Block ~]~ff...~..7..O ...... Lot ..... J. ............ Subdivision '~O~ ~-'q~-~ // ~'~ ~ ..................................... 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....~.~ l~/...~/~ .... 4.~.O' .~...~r:. ......................................... 11 tf b. lntended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... . Repair .............. Removal .............. Demolition .............. .,Other Work..~.~'.~.cT.~. ....... ~t~O, ~._i [ ~' ~ (Description) 4. esnmarea cost... ~ .... '. · · .......................... Fee .... I.: ............................. (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 .... i ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurgs, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same " structure w~th alterations or additions: Front ................. Rear .................. Depth ................... !.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new consffuction: Front ............... Rear ............... Depth ............... Height ........... .,~.. Number of Stories ................................... ) .............. 9. Size of lot: Front ...3 .'.~. f.. ~ ............ Rear . ~-:~ i/. .............. Depth ../~ ................ 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................. 11'. Zone Or use district in which pr~mises are situated ...................... : ................ .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.P ..................... '.. ~.~ 13. Will lot be regraded .../~/~.,~,.~ . .~.. ,,,~.., .... /... Will excess,_flll be removed from premises: ~ Yes 14. Name ~of Owner of premises .,-cB .T.,~.ff./.~ . ~".~..K.~ .°?.~.ZArld r e s s. ~.~3. . ~td¢ ~e~..........L~F Phone No .7G5.....7.,~/.~ ~... ..... Name of Architect .............. , ..... ~ ....Address . :_:,, ........ Phone No ................ Name ofContra°c~ot~ .t~- ~Y.'~./~' '~*/ .'~.~O0~:4~..~. Address~.b~)r~.¢P'°~ i ~ikll '. i i ....... Phone $o.,~5.'-:.~.~./.e~.... PLOT DIAGRAM Locate !clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines, Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or earner lot. STATE OF NEW Y,~R!~,//~__ o o ...... (~a' 'e ;f individual sfgl~i~'&'n't;ic'ti .......... being duly sworn, deposes and says that he is the applicant above named. He is the ~..f,:{<'..,~,~- .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements cont~ined in this application are true to the best of his knowledge and belief; and that the work w~l be performed in the manner set forth in the application flied therewith. Sworn to before me this Notary eubl,ic ................. i.,~ .~ County ~' ~.Uz~'H ~,~ ~mttll / (~gnature of applicant) BOI'A~y PUSLIC. State of New No.i $2.8125850 Sulfa k Coudltli/ , , k .term Exe res March 30, 19~'-'