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Home My WebLink About10197-z FOl~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10197 Z Date ........................................... , 19...../. Permission is hereby granted to: /'/ ~ at premises located at ........................................................................................................................... · . . pursuont to opplic*tion doted J4~ ' ~ 19~, *nd opproved by the Building Inspector. Fee ,....(.~ ............... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined ........ ~ 19'..~. Approved ...... ?. :~'!'~. .....1 .9~..~. Permit No. f~/..~..'~....~.-- Disapproved a/c ................. ....................... (Building Inspector) Application No. ff (f/ .......... APPLICATION FOR BUILDING PERMIT Date ............... 1 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 ~ving 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 Bmlding Inspector will issue 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 ~n part for an3~ 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,fgr'l)emo~l or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~fi,/_., code, hou~g code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~_~fc'~tinns. ~ ........ ...... ;;a'i ...... (,8igna~pplicant, or name, ff a corp t'on) ?. .zS. ?., (Marling address of apphcant) State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. Name of owner of premises .F.:ce.d,o~r~.qI~ .F.5,~ge.r~e..&..B.e.-~.%~. .F.i.n.~e?._l.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 .................................................. 6880 North Bayview Road Southold House Number Street Hamlet County Tax Map No. 1000 Section . .-.o.79:-9Y:-.o.o5 ...... Block .... 77 ............ Lot..~.. .............. Subdivision.. I~ee,aarcl./tcre~ .@. I3~¥vie~ ............ Filed Map No. ~75577 ......... Lotl¢ .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy . .r.a.n?.h..t.~p.e..f.e.n.c.e..(.f.r.o.n.t..o.n.l.y.).g..~.~.i.v.a.~.e..o.n?.?.a.m.i.l.y..d.w.e.l.l.i.n5 ........ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterationt ......... Repair ............ Rempval .............. Demolition .............. Other Work ....... / £enee . i (Description) 4. Estimated Cost. 200.00 i Fee .................................... , (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..................... 7. Dnnensxons of ex~st~ng structures, ~f any Front ............... Rear .............. Depth ............... Number of Stories Height ....................................................................... 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 ............... Nugtber of Stories ........................................................ 9. Sizeoflot: Front .......... : ............ Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ' . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. I .................. Address ................... Phone No ................ Address Phone No ................ Name of Architect ......... i ..................................... Name of Contractor ........ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back d/mensions from property lines. G~ve street and block number or descri interior or corner lot. -~ . Ranch-type fence - ~ } )tion accgrding, to deed, and sl~gw street names and indicate wheth~ STATE OF NEW-YORK, '/ ~ S COUNTY~OF .t_~/~..- .,~.. ~' ~,~ /.~ r' -~-~' ..... ............. an ,ay, ' (N~me of indivi~al signing contract) above named. He is the ................................................................. ~ .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is drily authorized to perform or have performed the said work and to m~e ~d file this application; that ~!t statements contained ~this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the manaer set forth ~ the application filed~he~ewit~. Sworn to before me, this ........... ~ ....... day 6f .... Nota~ Public, ~~~~ ~ ,i .............. .o1.~¢~'~ O, CountYeo~o~ ~~.~~ ~ , ~ // m ...... vu~z~C, Stat~ o~ m~g~. · ~ '/ ~ (SignOre of applic~t)