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HomeMy WebLinkAbout11425-z BUILDING' P, ER~IT, ~ (THIS PERMIT MUST BE KEPT ON T~H,E PREMISES UNTIL LL coMPLETION OF THE WORK AUTHORIZED) N? ~1~25 Z Do~e .......... ~ ........ ,..~,..~ ...................... , permission is hereby granted to: ~ ~ ~ ............. ~.~).~.~4~ ~.~. ~V ~ ~f.~: ~ b ~:.Z.a~ ....... ~c.<.~.;~:~;~..~....:~.~z~.~.c~ ~¢...~ ................. ~/~t) ~10~01~ ~ ................ ~ ................................................................ ?L.H., . ...... ~ ~....~. .... . . ...... L...L.. .~ . · A:... ..... ~.: .........~ ................................. ~ ' . , ; ~: ' ., . ~/ CoUn~ Tdx Map No. 1000 Section ......... ............... Bl~k ~,.4~....,.l.....~.,~L0t ........................ Building Iflspector, ~ ~ Rev( 6/30~0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:a Examined ................ , 19 ~ //-/~ 9~q ..--~ l] I,/~ _~ Approved ...... .....'. ..../. ...... (Building 'Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , . INST RUCTIONS a. This application must be completely filled in'by typewriter or in ink and submitted in triplicate to the Bui[di 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 promises or public stre{ or areas, and giving a detailed descriptiou of layout of property must be drawn on the diagram which is part of this cation. c. The work co~emd by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc,'al of this application, the Building Inspector will issue a Building Pem~it to the applicant. Such pern shall be kept on the premises avagable for inspection throughout the work. e. No buildiug shall be occupied or used in whole or in pa~ for any purpose whatever unt~ a Certificate of Occupan sh~l have been granted by the BuQding Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances,~ilding code, housin~e, and regulations, ~d ¢ ~S~re~ppli?~t,~r name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eIectricia~x, plumber or build.. Nmne of owner of premises ....................................................................... (as on the tax roll or latest deed) lf~cant isa corporatiffnffnff~, ~t rue o.~ d.~ authorized officer. .. ( Builder's License No .......................... Plumber's License No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... Location of land on which proposed work will be done .............................................. ...... .... &, .......... ................ House Nmnber 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 .... S~.~ ..... ~"~-"~'~ ~,,~uz ...... b Intended use and occupancy /'.~. ~'.~. '~ ). Nature of worky~(zheck which applicable) Repair ..... /..~. ...... Removal ... , Estimated Cost .~..~..~ .... ;. If dwelling, number of dwelling ~[Bit~...;.. If garage, number of cars .... ./[,....r_...~. i. If business, connnercial or mixed occupa ~. Dimensions of ex)sting stmctur{s, if any: Height~ ..../.1~ ......... Nnniber of Si Dimensions of same structure with altera Depth .................... '.. Heig] ~. Dimensions of entire new construction: ). 1. 1. I. New Building .......... Addition .......... Alteration .......... .......... Demolition ............ Other Work ............... (Description) . .~?~ / ·., (to be paid on filing this application) ./..~..I... Number of dwelling units on each floor ................ Front...../~? ...... Rear ...'~.. Z ...... Depth....~..."~. ...... eries .... ~..... ............. >.~ ........ .; ......................... ions or additions: Front .... ,~. ~. Rear .................. Height ............... Number of S 'eries ........................................... ......... Name of Owner of premises . . X C.r. ~. .... Address ................... Phone No ............... Name of Architect ........... ~ ~., ....... Address ................... Phone No Nme" of Contractor ......... . .~ ~ .... Address ................... Phone No ................ Locate Clearly ,'md distinctly all buildinl roperty lines. Give street and block!number :terior or corner lot. PLOT DIAGRAM ;s, .whether existing or proposed, and. indicate all set-back dimensions from >r ~lescription according to deed, and show street names and indicate whether rATE OF NEW YORK, f S.S OUNXY OF ........ '~ - · '" · · e is the ....... i .... .--,- f said owner or owners, m~d is duly autho )plication; that all statemcats contained in 'ork will be performed in the manner set for worn to b~fore me this ....... ~ .............. day of ..... otary Public~ ~~,.~../~. ;... .... - I~MtGARET ~, STAN~E¥tCH.. kj ' ,Commission F, xl~,rM M~r©n ~,'~ ~r being duly sworn, deposes and says that he is the applicant [Contractor, agent, corporate offic,~r, et~.) 'ized to perform or have performed the said work and to make and file tJds this application are true to the best of his knowledge and belief; and that thc :h hi the application filed therewith. (Signature of applicant) 2;~ q ~' 3 rr~r~ ~) S,e- ~T~O~ Z. g ~o -nas ~m, rr ~s ./, ~lo~auo~ o~ ~l?~T CERTMCAI'E OF OCCUP~,Jg¥ J t L 2 u.p l='LOOl'~ PI_AM ,Oi=FiC F'' 0i I i __.1 ......... 1 N~-W ~¢x~¢ HCTCI-i T~ S ~(DTF'-S (~ .5OUT 't F LOOP-., ,,;'4 J 0 ,r t! f f' _/ IN