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Home My WebLink About10841-zN? 10841 FORM NO. 2 TOWN I~F $OU*I~E£ BUlLDlUG DEPA~T~E~ TOWR HALL SOUTH'OLD, N~! BUILDING PERmiT COMPL~TIO~ OF THE WORK AHTHORIZ[~ 5ES UNTIb FULL Permission's hereby granted to: .. ~..~..~.,~...4.~,~ ~....~.i:.. ........ ~.....£.z~......? ...... : ................. :... ........ ~~~.,.~......~... ,, . ...... ? Lot No. 0'/~' .......... ........... 19 ., *nd opprovod by the pursuont to oppllc~tion d~tod .............. ~.~ ..... Building Inspector. Fee $..[.~ .............. Re¥. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765q 80~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~kl,~l/,$'.~...../.~.., 19 ~., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~~ 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 th~s 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 Bmlding 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, bhilding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...'2T..~3.~....~.,r~.. ~.~<.~.e~-...~: .............. (Signature of applicant, or name, if a corporation) %.~.~.. ~ ~..,I'1.~.:~.~....~..~ ..... o.*..~..~.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... e~,~.a,.~..0~, ............................................................................ Name of owner of premises ...~.~..~..~D. .... ~.o..~.~..~-q .................................................. las on the tax roll or latest deed) If applicant is a corporation, signattlre 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 .................................................. ~ ~0...~....o~.~.. ~ ...... C.O. ~.,.q~.~,...~. ...................................... I~;~id ~'umber ,~fir/~ ~ ~' ...... Stre~i ...... (1 ' Hamlet ' County Tax Map No. 1000 Section .../~..~.. ......... Block .... .(~...~.~.' ........Lot...~. (..~. .......... ' 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 b. Intended use and occupancy..~ .~. ?..~.~.. ?O.~1 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat&gn~ _ .......... Repair .............. Removal .............. , Demolition .............. Other Work .'~.~.~q~.~.~..~ .... (DescriptiOn) 4. Estimated Cost ~ ~/.O, OO ..' ............. Fee : ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor .............. If garage number of cars ............................... 6. If business, commercml or m~xed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structure§, if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... Dimensions of same structure wiih alterations or additions: Front ................. Rear ................ Depth i Height .......... Number of Stories .................... .... pth 8. Dimensions of entire new construction Front ............... Rear ............... De ............... Height ............... Number of Stories ................ ~ .......................... /. ............ .9. Size of lot: Front ........ ~.O..~'. .......... Rear ....... ~O ........... Depth ....~. P.Q ......... 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: ................................ Name of Architect .......... --: ............. ]... Address ................... -- Phone No ................ Name of Contractor : Address ................... Phone No. property lines. Give street and block interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether - y' STA'iE OF NEW.' ql~l~, ' ~ S COUNTY OF.. u.4Cgo ..... .... ..~....~.'.~.~'Cr.;, ~.O ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigoing contract) above named. ~He is the ..... ~ ~O.~. ', .................................................................... , . (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is ddly autho~zed to perform or have perfomed the said work and to m~e ~d file this application;that all statements conianed work w~l Ce perfomed in the m~n'er set forth in the application filed therewith. Sworn to before me this ............'~l~ ..... day of. ~[t~.q.~ ~ 52'4524271~~~ ~ ..... ~v,,us ~arch 30, 19~ ~ [ [~]gna~ure ol appllC~[)