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Home My WebLink About10951-z FOI~ NO, ~ TOWN OP S, OU, THOL~D BUlLDm~ TOWN ,HA~L SOUTHOLD, N. Y. BUILDING p,ERMITI (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AuTHoRIZED) '0~ obe~ Per~nission is hereby gronted to: ~ ~IN et p~emises Iocoted ~t ............................................................;,,,,,~ ................. ~,, ...................................... Coun~ T~X ~op No. 1000 Sochon ........................ Bilk ,...~ ........... ,...~Lot No.~ ........................ pursuant {o ~ppl c~t on deted ........................ ...L...., 19...,.;..., ~nd ~pproved by the ~ull~lno O0 Rev.~ 6/30~80 : : FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-18013 Exam ed ....... Approved ................ ~7~/f~°'~.i 1 .~./Permit No.. ........../~qS'/ Disapproved a/c ..... ~Z2~_' ' ' .~'~' ~'~ '_~__' .' .'~'_ ......................................... ........ ../5~g~.~< .~../. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.. / .~..~.. ~.~.(. ..... 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 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 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 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, ordinance, s, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neces~nsp~~ /~ f. k/~3 ~(Signatu~ o~ap~pli~.,.o_~e, if a corporation, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 5 .......................................... (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~..~.~.~¢~.e[:~?~..../~. ~? ..................... .. __.. o r- I ........................... .,,.~,~..~'~..,/,?~. 4~/~ ............... House Number Street Hamlet No 1000 Section ~. County Tax Map ....... ~ ....... Subdivision ....... · .~. · . .~ ~ .... ~ .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... . .~... ¢..~L~. ~ .~......~'.~q.' .................................... b. Intended use and occupancy~..~....~?.~. .~.dLJ/....~..~'~?..C..~..~.q. ~?~...~.~...~ ..................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val .......... ~,..~ Demolition ............ ,.~ Other Work .,,-~. · .......... 4. Estimated' Cost ~...~.~' .. Fee "' · i ' (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ' ................................................................... 6. If business, commercial or mixea occupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structurls, if any: 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 ...........i ........... Rear ...................... Depth ...................... 10. Date of Purcliase ........... : .................. Name of Former Owner ............................. 11. Zone Or use district in which promises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regmded ......... : ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect .. . i. .. Address ................... Phone No ................ · ~ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. NEWFY~K, STATE OF ........... ~ ...... ~ . .~~v~, . . being duly sworn, deposes and says that he is the applicant (l~a,m'e of individual signing contract) ~/ above named. He is the ..................... ~r-fe-t.-~rk~. ..................................................... (Contractor, agent, corporate officer, etc.) of sakl 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 before me this ~i }IONo' 52-81258§0, Suffolk Co~ ~'/ L/ i ; Term Expires March 30, 1~..,.-~