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Home My WebLink About12525-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) 12525 Z Permission is hereby granted to: . (~ c (~ ~~.......:..+.~.....~.~ ....... ~..~ .... ...~.~.~. ........ ~.~ ........................................ , ,o....~.~......~.,,.....~ ....... ~,.~.....~.~,.~..~..~.....~.......~.~.~ County Tax Mc~p No. 1000 Section ~.....~....1 .......... Block .......... t ........... Lot No ........ .J../~.. ........... pursuant to applicotion dated ........~.......~...[ .................... , ig.g..~.., and approved by the Building Inspector. 6/30/80 : FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Approved ' ~'1' ' '~'<{'" 19x~'~' Permit No. [ '.~.~..~.~..~..~.. Disapproved a/c ..................................... Application No.. )..~-.?..22r .~. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 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 BuildLng 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 O~dinance 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. ..... ............... (Signature o~Applicant, or name, ifa corporation) /. ./??. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .~o.O.' ........................................................................ Name of owner of premises .... . ./~/.~...'~'. .... ."~.. '..~.~..~ /~ .;T/~'d-~'. ................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly 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. Location of land on which proposed work will be done .................................................. .... ............... .......... .¢.. ....... House Number Street Hamr~t County Tax Map No. 1000 Section ..... .~..I .......... Block ....... I ........... Lot... J..~.. Subdivision .~.t.v.O~t.t~..O..[7.~.....~..~.~..~'-~...~- -~ ...... Filed Map No. 3.7fl.. . ...... Lot... 7 .... .~.'.... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 0 De ' ca, b. Intended use and occupancy . .(2) fl°,- .'. . ~ .... , ./W'././~. ..... /..~.~..~-d.. ........................ 3. Nature of work (check which agplicable): New Building .......... Addition .......... Alteratri,on .: ........ Repair .............. Remqval .............. Demolition .............. Other Work .-~..O ~ t. c3,~ ..... ~ , ~-, (Descri~ltion) 4. Estimated Cost ....... .Q..Q ~(SQ~ . Fee (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If busihess, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~menslons of existing structures, ff any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wtth alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 10 [)ate of Purchase I Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: ................................ 13. Will lei be regraded ......... i... ,.. .......... ,'1:-: · Wall excess fill.be removed from premises: Yes No 14.Name of Owner of premises . ~'~.~/7...~.K. Op. g./(.dA'fAddress .ffOC~./~! ..~-d..:~A~r(o.~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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~':~DRK, , COUNTY OF ..~ ~,~.E°.LL¢:- ....... ......... .~.. <~~.~ . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..... ......................................................... (Contractor, agent, corporate officer, etc.) of saki owner or owne~, ~d is duly autho~zed to perform or have perfo~ed the said work and to m~e and file this application;that ~1 statements contorted ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ........... .......... . ? ..................... [ ~0~~"~ ~ (Signature of applic~t) /