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Home My WebLink About10802-z ~o~ ~o. BUlLDI.G SOUTH'OLD, N~Y. BUILDING PE~T: (THIS PERMIT MUST BE KEPT ON THE PI~,EMIS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) Permission ~s hereby gra~ted to: Coun~ Tax Map No. 1000 Section .............. Z.,,,,;, Block ~.,,,~ .......... ~,,: ~,Lot No ............... ~ .... Building Inspector. Fe,~ S../..~...i ........... Rev. 6130/80 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.. Approved.. Disapproved ~/c ...... ~ '~:~'D~ ........................ ....................................... ~ (Building Inspector) Application No .... .-'.':. :":'. ....... ~.__ APPLICATION FOR BUILDING PERMIT '"x Date .... / '~'.NX.~ INSTRUCTIONS a. This application must be c~letely~fi[led in by typewriter or in ink and sublnitted in triplicate to the Building Inspector, with 3 sets of plans~Z'~u~e plot pla~.to scale Fee according to schedule. b. Plot plan show,,ing Ic~t"tion l~t' l~,,~nd of bh~ldlngs on premises, relationship to adjoining premises or public streets or areas, fi~d giving a detailed de~cnpfion'~layou~ of property must be drawn on the diagram which is part of this appli- cation. X I ~ c. The wo'lq~ covered by this ~pplication may not be commenced before issuance of Building Permit. d. Upon ap oval of this application, the-l}mlding Inspector will issue a Building Permit to the applicant. Such permi[,~ shall b e ~°e~ adn~t~apl remises available fgr~peB~od~ throughout the work. e. No building ~lq~ll be occupied o~xuse~ w'l~l~or in part for any purpose whatever until a Certificate of Occupancy shall have been grante~ the ,,Buildin.g~e!~or.X APPLICATION IS HI~EB MADE to the Building l~artment for the issuance of a Building Permit pursuant to the Building Zone Ordinance o'Y~h~ n of Southold, Suffol. ~ka~ounty, New York, and other applicable Laws, Ordinances or Regulati.o. ns, for the construc.'~ bui dings, addltion~i~'~a~rations, or for removal or demolition, as herein described. The applicant agrees to comply all appli~al~,~i~s,oordinat~es, building code, housing code, and regulations, and admit authorized inspectors on ~ for neces~a~r~, inspections. State whether applicant is owner, lessee, .................. Name of owner of premises ........ ~.~. ~.~...~..~-. (Signature of appilcant, or name, if a corporation) ~'~ ;'~; '~ (Mailing address of applicant) architect, ngineer, "general contractor, electrician, plumber or builder~ (as on If applicant is a corporation, signature of duly aut (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. ~. E~.../.--. ~/-Z?~%2..O...~.../.q.O. ?..~.~.~.~.. ~ ............. ' .......................... Street Hamlet County Tax Map No. 1000 Section ................ Block .................. Lot ................... Subdivision ................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ . ,,~./~?. ~ r/ .~/~ ~/ b. Intended use and occupancy ...... : .......... .:'. ..................... / ......................... 3. Nature of work (check which aptohcable): New Building .......... Addition .......... Alteration ..... ...,. Repair .............. RemoVal .............. Demolition .............. Other Work,5~&'Z/?A~.~. ~"(~.~-i q'~pS~, C~ [ .~..,~.. (Description) 4. Estimated Cost ................. .--:...~ ............... Fee ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling dnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... , .................................................................. 6. If business, commercial or mixedl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i · 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 ........... ~ ................. Name of Former Owner ............................. 11. Zone or use district in which premises 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 ... '. ................ Address ................... Phone No ................. Name of Architect .~)-~.,. ~g')~... Address ................... Phone No.~. ?~.: ./..o~.~.7 . . . Name of Contractor .......................... Address ................... Phone No ............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ?1 STATE OF NEF YORK ..... ... g~.. ~.'... ~ m 0g& ................. being duly sworn, deposes and says that he is the applicant (Name of individual signhg contract) above named. He is the .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 manner set forth in the application filed therewith. Sworn to before me this.~ .......... , day of_ ......... ~OT^RY pU~,LIO, ~ ~ew ~u ~ qual,tled *n Sut . . . ~q0~ /(Signature of~plicant)