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Home My WebLink About10842-z TOWN OF ~OUTUQ~p BUILDING TOWN HALL SOUTHOLD, BUILDING P,ERMt'rl (THIS PERMIT MUST BE KEPT ON THE PRE IS S COMPLETION OF THE WORK AUTHORIZED) 10842 Z Dot~ ...~ Permmsion is hereby granted to: /~ _ ~, ..... UNTIL EULL ......... ' ' '" ¢. . ~Lot N O~ C~n~ Tax Map No. 1000. Section ,...0...~..(.....,. Block . ~,.~.~ ......... ~ 0 ..... I. ........... ~ , and approved by the Fee $ ......... R~v. 6/30/80 BUilding Inspecffor FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No..~.(~.~. c.~.. ....... 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 apphcation 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 ~nspection 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 Bui/dmg 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, b~ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections· .......... (Signature of applicaht, or name, if a corporation) ·. O.vC.T.c%. .................. (Mailing address of applicant) State whether applicant is'owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises . .~..v~. .... .~hl.~. )~ .... .~..I..O~y. K ........................................... | (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· .......... ne,. (Name and title of corporate officer) Builder's License No .... ' .q.~. ]. ~ ............... Plumber s LicenseNo ......................... Electriman's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House number O~-cOO /~--~-~c/ ~F. ~Street Hamlet County Tax Map No. 1000 Section .... ~...~..d ........ Block ....O...~. .......... Lot..OO/. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ...o. :. } .... d .c..llt ..................................... a. Existing use and occupancy b. Intended use and 6ccupancy .. ~..v3e~. :..~.'~..~..s.~.h(....~.~.ew~.~.l.~.q 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~n ..... ; .... Repair .............. Removal .............. Demolition .............. Other Work ;-~ ~.~. ~ .~.. · (Description! 4. Estimated Cost I Fee ,. : (to be paid on ~ing this application) 5. If dwe!ling, number of dwelling Units~ ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dtmensaons of ex~stmg structures, ff 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 ............... Nu~nber of Stories ............. 't ............................. / ............. 9. Size of lot: Front ......1~9..~ ........... Rear .....~X~..O. .............. Depth .... /..~. · .............. 10. Date of Purchase .......... ; .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. I)oes proposed construction violate any zoning law, ordinance or regulation: ................................ ~13. Will lot be regraded ........ i ....... Will excess fill be removed from vremises Yes No 14. Name of Owner of premises t~.~.~....~./(~?.~...Address~.O, ma~o~e~.~0c,,.'.~..'~oneNo..qqa.-..~.~.~.~... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW-YORK- COUNTY .... i ...'~.....'~..ct..~.~.,...P-~...~...! ..................... berg duly sworn, deposes ~d says that he is the applicant (Name of individual sig~ing contract) abow~ named. He is the...~~. · .' .................................................................... (Contractor, ~gent, corporate officer, etc.) of said owner or owners, ~d is d~ly autho~zed to perform or have perfomed the said work and to m~e ~d file this application;that all statements contained ~ this application am true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~er set forth in the app~cation filed therewith. Sworn to before me this . ............ /~ day;f .... ~ ~.X .~, 19 .~ ~ , Nota~ Public, ~o~¢~[c.~t~,.~~~"°wm's~ ' ~ ~ '7. Y · · ,,~' ' ~a~,tt0a ~n s~.~,~" F // (Signature of applicant)