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Home My WebLink About12167-z12167 (THIS PERMIT MUST BE KE~T ON ~HE COMPLETION OF THE WoRK AUTH6RI'zEDi Z Date p~rr ~ission is hereby granted or. p 'emiseS located at ........................ , .......... ~L~/~ ,~i'" Co'?~ty Tc~x Map No. 1000 .Section ~ ...... ;,;....; ...... pursbant ~o application dated .... ~ .......... 1Lot NO ......................... 19.....~.., and apprOved by the Jo~ M. · ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined ......... ?.~/.j .?, 19 .fi'..'~ Approved ........... '.~.., l~Pe=it No./?.( ?..7...Z-- Disapproved a/c .... ~L~i-~'-": ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... 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 authorized inspectors on premises and in building for necessary inspections. admit ...... ,0.~.~ .~. ~.~.~. ~.~._; /:..~:&~. ?.~. .~-- (S~/a~fYe ~f/applicant, or name, if a corporation) .............. ~ .............. ./.7.9.-.0. .... (Mailing ad~I~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (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 ..... 5 .~.~...~. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ........ ~ .ce.. ~. . ........ ?.~ ~/. .5.0. ~c.z~. . /.~. . .,. ....... . . .A~. ~.o. ~. :~. ..................... House Number Street Hamlet County Tax Map No. 1000 Section ........ [. !..7. ..... Block ....... ¢ ........ Lot.. "~'~ '7. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ......................... b. Intended use and occupancy . ~ .I ~..4~.../~..~..fi_.. ...................................... 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteratiol~ .~. '~ Repair .............. Removal .............. Demolition .............. Other Work. 1~. ~./~ .~i~.~-i ' i i i ' .5-..? rD g ?DJ escription) 4. Estimated Cost ..... P' '/'~'!' i ......................... Fee ............................... ~ (to be paid on ~ing this application) 5. If dwelling, number of dwellingiunits .......... ~ .... Number of dwelling units on each floor ................ If garage number of cars i 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .-.q~J~.'. ~.u.f.~. ~... Rear .............. Depth ............... tteight Number of Stories -- Dmaensions of same structure wlith alterations or additions: Front ................. Rear .................. Depth ................... :.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tteight ............... Nuatber of Stories ........................................................ 9. Size of lot: Front ~..~.~*..~ff.~. ~. .... Rear ...................... I~ep~h .~ ....... ~ ........... 10. ~ate °fPurchase ~qO~.~ ./.~o~/. .... /.. ........... Name of Former Owner ?.9.~.& ~/~.e¢/~/(. ............. 11. Zone or use district in which pr~mises are situated ~. ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: N t9 13. Will lot be regraded .. ~/.o.... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises~.~..~. J~l~q~-t~ ...... Address ~ .x./~?...A~?'.oy.5~.fi~..~(~..Phone No.~.~.:~.. ~.~ .... Name of Architect ......... ; ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions f~om property lines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, !S.S COUNTY OF..-.':q.q .F.~'p.z..~. ..... ..~'~TCr' c/ . .~../~.K.~?~. /¢//i/sz/~ 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 said owner or owners, and is duly 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 manne~ set forth in the application filed therewith. Sworn to b~fore me this day o~~'7~z~r~ ~tt'.~ 19 Nora .fy Public, . .~. .... ~OTARY PUBI. IO, Stale of Ncve Yorl~ ............... .~, ~,--r~e-,n' .............. Iqo. 52-4524171 j '~ '~ ~ 'C~ (Signature of applicant) Qualified in Suf/olk ¢odnty ~olllmisslon E×plras ~arch ~0~ 198;~