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Home My WebLink About12526-z FOB.I~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .... ....~.~,t~..~.~. ......... .~ .............................. ...... .~..~,~. ............. ~ ........................ at remises located o, .~.c].~..~.0 ...~..~..~...~. p .................. ~. .............................. ? ................. pursuant to application dated ......... ~.......~......~:...J .................... , 19.~..~., and approved by the Building Inspector. Rev. 6/30/80 Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOW~ HALL, SOUTHOLD, N. Y. 11971 765-1802 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ · ..~/~..~.,:~./.~.~ ~ ..... ~~..~d .~.aur.~../.o.~..~..~t'......)~.. .......... PLEASE TAKE NOTICE that your application dated JU/V~ ~zT/ 19 ~ for pe~it to construct...~~/~... ~2~.; .................... ~ ....~.. at~ ~ouse No. $troot / ~ Hamlet County Tax Map No. 1000 Section .. ~ ...... Block ...~.~ ....... Lot . ~ .~ ..... Subdivision ................. Filed Map No .......... - ....... Lot No .................. is returned herewith and disapproved on the follow~g grounds .~:~(~...~~. ~ ~. . . ~.e -. ~ .~' . .~ ~ ~ ~ . . . ~ ~/ ~. ~ . . ~ . ~ .... ~ d'~) ~. : ~ . . . ~ ~. . ~.o.~ ~. . . ~¢~ .... z~. . /.~/~'~. . .~ ~'. . .~c~.~T. . . RV 1/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date File No ................................ ...... PLEASE TAKE NOTICE that your application dated ..... ~..~. .... .C~./. ......19 .d...~... Z c'"- for pennit to construct...~.~.~..O../~. ,.q....~.,)/.(~¢~f ..... >Y .......... ;, ......... ,~ ..... ~. at Location of Property c:D'/~' ~,.~.~.~..,(%'..~..~.' ?.~/.7~...~..?/..~.~./~,~/.~..~..t~-/~.~.'~.'.,.. ~ hi~s'o hid .......... _ ,'~ / stroet_,v /~, ~ ~ / County Tax Map No, 1000 Section., ¢?'.(5. ~.. ..... Block .... ~,, O~.., ..... Lot ,,..C4,~ ,~.. .... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds../.~..,~I. ~../.,5¢'.t~,.~.,:~..,..~?,5.~..,~. ..... / RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654802 .... Approved.. .: l;g. Permit No. Disapproved a/c ..................................... Application No.. ).7. 7..°7'.~..~. ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 regul_ations, and to admit authorized inspectors on premises and in building for necessary inspections~ ! ~/ , /~ /?, ~ (Signature of applicant,~ name,, if a~corporation) Z,)(Mailing address of applicant) State whether applicant is owner, lessee, ageht, architect, engineer, general contractor, electrician, plumber or builder. ' Name of owner of premises .... i.~...~ ~ (..CMD. ...... .~. .... (.F.1..C).. f.~. !~' ................... (as on the tax roll or latest deed) If appli4ant is,~ corporation~4signature o~luly auth~ized officer.. (Name and title of co,orate 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 .... ~. {~.0... Y( ..... .............--'J .......................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~ .T .......... Block ..... Lot ¢ Subdivision ..................................... Filed Map No ........... )... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrhction: a. Existing use and occupancy .... ~. ~. ~.. :... ~ f.5¢..f ~ (~ h b. Intended use and occupancy ............................ ........................................ 3. Nature of work (che'ck which applicable): New Building .......... Addition ~.......... [ ~' t~/ .'Alieration .......... :Repair .............. Rem .............. Demolition .............. OtherWork. ~/. ~,~. ~ ..... 4. Estimated Cost .................................... Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwellin :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 structurbs, ifany: 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 construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front : ...... Rear.. Depth ...................... 10. Date of Purchase ..... ~ .T. ?4. ~- .............. Name of Former Owner ... ~).0 ff..~.4 .& .~.... ~..~. ~... 11. Zone or use district in which pr~mises are situated .~ o .r~ .~ ~ ~.. ¢/~ ~. 12. Does proposed constructmn wolate any zoning law, ordinance or regulation: ...~t~..~ .................... 13. Will lot be regraded ..... ~J~..~! ....... z .~t ......... Will excess fill be removed from premises:, Yes No 14. Name of Owner of premises .Wi .~. 0~ ?. ?.¢ Address ................. Phone No. ~.~'. ,~T~] 2. ff ~.... Name of Architect ' Address Phone No Name of Contractor i Address Phone No . PLOT DIAGRAM Locate clearly arid distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!number interior or corner lot. ~ or descripti~ according to deed, and show street names and indicate whether ' STATE OF N~"ORI~ / S S above named!Name of individual sign!ng He is the ~:. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dulg authorized to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the mmner set forth ~ the application filed therewith. Sworn to before me this .... ~ ...... ~ ..... day of~ ........ ~~..., 19~ / N~ublic, .:>~ ................. ~:~~ty. · .~~Cou~ ':~: ~.~~ ~ 40~¢PUBLtC/ State of ~ew Y~ -N~,~ff~lk COU~, (Signature of applicant) , , term ExCres March ~0, 1'~ / says that he is the applicant