The URL can be used to link to this page

Home My WebLink About12205-zPer~issiori is hereby granted to: ~ BUILDINGi~ (THIS PERMIT MUST BE KEPT ON ~HE COMPLETION OF THE WORK AUTH~RIZI~I~i Rte prem~sea-~- ' ' located ........ COb~ty Tax Map No. 1000 Section,......;.::........',~t~.~,Bi~E p?s~ant tO applicatlondat" ........ Bull~lng I pector. :'' 19...~ and approved by the FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .4. t'q~.~¢/~ .~. .... , Approved .~. a~..3 .... , 19~9~. Permit No./&,~ Application No./*P-. ,~- ?...~-...~..: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ..... Oat. e,...~//.~. ............ 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 issu~ed 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 tke 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 auth°rizedinspect°rs°npremisesandin building f°rnecessaT~ .~._? ~ ~ ~/(Signa(ure of applicant, or name, if a corporation) (~lmhng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~o.S e.12~....,ff],./~/'7 d/7.t~..q/.e~,: .~.~.. ~. .................................. (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 .................................................. .. 3.3. . . .nd. ...................... .,q. .77. . ' ........................ House Number Street County Tax Map No. 1000 Section .... [..~. .......... Block .. .... o~ ......... Lot...,ff. ~) ........... 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 ........ ~..d;..('¢..~...~.....,~.0..~. ........................................ / , b. Intended use and occupancy ....... ~....~ .... ~.,/d.~.. ~?~.~ .......... 3. Nature of work (check which apphcable): New Bt~fl/hng .... , ..... Addition .......... Alteratio~/~.s '.',' ..... Repair .............. Rem6val ........... ~.'), Demolition ......... -' Other Work .~... ~/ ' (Description) 4. Estimated Cost .../'ff.. ,.~ ......................... i ....Fee . ./, ~.~ .~. ~/. ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling t~nits ............... Number of dwelling units on each floor ...... ~ .......... If garage number of cars i 6. If business, commercial or mixed occupancy, specify natur~ and extent of each type of use ..................... i ..... Rear ...... Depth ............... 7. Dimensions of existing structurels, if any: Front ......... , ......... Height ............... Number of Stones .......... l .............................................. Dimensions of same structure with alterations or additions: ?rent Rear Depth .................... :.. Height ....................... Number of Stones ...................... Q~) Dimensions of entire new construchon: Front .......... i ......Rear ............... Depth .... Height .../~.~aa~. ..... ]~lmbe~ef £tmdes . ~'..~q.t//q~..Ck'.r~.~ .'~s~ ........................ .t ........ 9. Size of lot: Front ....... ~_'.~.. :~.e.e.~. ..... Rear ..... i.~.~ F-.ee ~.. ..... D~pth . ./.t/q, ............... 10. Date of Purchase ...(~/~/~. ................ Name of Former Owner ./Tt~/~.. ~.~4~4~.~/t. .......... 11. Zone or use district in ,khich premises are situated I :. ./.. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .... /~&..~f/..~'..~. · .,~ ·., ....~x ~gj.ll excess fill be removed from premises: Yes 14. Name of Owner of premises ~aselOh.//.'.'J. r/d~d.F~J~ff'd~dss $J.~.~ly~.9 ~e/~.~..7~' Phone No~;t~ ~.~.~. -- Name of Architect ............................ Addiess ................... Phone No ................ Name of Contractor .......................... Add~ess ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existin;g or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description acc{rding to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, . COUNTY OF .~'tl..f:.~.0 .L.~ ..... iS.S ...... ~J"~. ~/9...~.,..AJ0 .~..F~..~.~./..~J.~. ~. ........ ibeing duly sworn, deposes and says that he is the applicant (N~fme of individual signing contract) above named. He is the ................ 0 .......................... ~ .............................................. i (Contractor, agent;, corporate officer, etc.) of said owner or owners, and is duly authorized to perform o~ have performed the said work and to make and file this application; that ail statements contained in this application ar. true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicafio filed therewith. Sworn to before me this ................... day of. ...~. ............ ,19... Notary Public, i ..:'~.... Cou~t (Signature of applicant)