The URL can be used to link to this page

Home My WebLink About11083-z FORM NO. l~ Town Or, SOUT.OU, i~ BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N, Y. BUILDING FER~IT (THIS PERMIT MUST BE KEPT ON THE PP, EMIS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11083 Z Permission is hereby granted to: ............. ~..:/.~h/.~.~....~z ~.~..zZ..~.. , .............. .......... /.L/.~. ~Z:/.~.~..~..,~/..:..~<.:.. ........... ~o ....... ~:.~.~.~......~ ...... ~ ....... ~c~.~...~wz~ ..................................... ......... ~z~..~.:: ....... ~~...~..a~.~.z~ ........... ~.~c ~ ........................ at premises located at County Tax ~op No. 1000 Socfion ...~.~ ....... Sloc~ ..... ~O..J2 ....... .Lot ~o...0.~.~.~ .... pursuant to ~pp[i¢*tion dotod ...... ~ ........... ......, 19. and ~pproved by the Building Inspector. Fee $.,.L.~.,.~: ..... Building dnspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 xamined ...... 19 / ,pproved ........ 1Z. ?. No. z/o.Q ? )is*approved a/c ....... .......... ~. '...~5~ ......... /~ , ...................... ::'"i ............ (Builh"ing Inspector) ~ APPLICATION FOR BUILDING PERMIT Date... ~.~/,~. 6 ..... INSTRUCTIONS Application No.. ~,/..~..6ff...ff. ...... ., 19 rY../ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building .nspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining promises or public streets )r areas, and ~ving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 'ation. 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 ,hall be kept on the premises available for inspection throughout the work. e. No building shalI be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ;hall 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 3ui!ding 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. ['he applicant agrees to comply with all applicable la,as, ordinances, building code, housing code, and regulations, and to ~dm~t authorized inspectors on premises and in buildings for necessary inspections. .. ~'g..L £.~ v.¢~.c.~. .( ~.4 .4 .... ~.~/-/~4 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....~..o...,,~-...~A.~.~ .~.c e . ~ . .t .... ,/g. t .u. ~ .< ,'. .~. ,4 . 4 . . . ~ . ~. . .~. . ?. ~. . . .c. . .~ ,, ................ qmno or owner of premises . .~...".~.~ ¢.~... ~ .'~.. 0...~../~c./,r..t7~. .R. t~.~c. ...... ../~...~. (<./..~-..f.~ .................. (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. '.~xc/~''/' '''~'5t ............ Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..... ~.~ .:7. ......... d. ~ .~.~.~..-r./'..o. ~..~ ..................... ..~. ~ .v.-:. ~..: .~..~. .......... House Number Street Hamlet County Tax Map No. 1000 Section ...... .~. f.~....-'?~'<U'... 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 .... ~...~..~...'q'3./..C....~..../(-1/'..o.,~..~_ ................................. b. Intended use and occupancy ........ .~.~...A~.. ~ ................................................ Nature of~rk (c~eck whicl~ applicable): New Bu//ding .......... Addition .......... Alteration ~. ......... 3. ' ~ Repmr .............. Removal .... '...~ ....... Demolition .............. Other Work·..ti(... ~.~. ~-e.q (Description) t Estimated Cost (( ~ ~ ~o Fee .'~../..-~. ~ (to be paid on filing this application) L If' dwelling, number of dwelling Units ............... Number of dwelling units on each floor .............. If' garage, number of cars ............................ i ......................................... ~. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ............... Nutnber of Stories ...................................................... Dhnensions of same structure with alterations or additions: Front ................. Rear .............. ';. Depth ...................... Height ...................... Number of Stories ..................... I. Dimensions of entire new construction: Front ............... Rear ............... Depth .......... ~}. Height ............... Number of Stories ....................................................... ). Size of lot: Front ....................... Rear ...................... Depth ..................... ). Date of Purchase ........... : .................. Name of Former Owner ............................ i. Zone or use district in which premises are situated .................................................... !. Does proposed construction violate any zoning law, ordinance or regulation: ............................... t. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No [. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ 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 · opex~3t lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. 'FATE OF .N, EW YORK, .... ou~rvo~.~a~: . ~.~ · .~-~? .~..~. ~. t~.ff..~%.. ~..... ~'~'.~ ~ .............. being duly sworn, deposes and says that he is the applic~t (Name of individual signing contract) oove named. ~ ~ th~ ......... ~ .~ .~ ~ ..... a ~. ~.~.~ ~.~. d h..~ ~. ~...<.e ................ (Contractor, agent, eorpgrate' officer, etc.) f said owfier or owne~, ~d is duly authored to perform or have performed the said work and to m~e and file ~is pplication; that all statements contgined ~ this application are true to the best of his knowledge and belief; ~d that ~e ~ork will be performed in the manner set forth in the application filed therewith. worn to before me this ....... ta ........ ........... ... .. LINDA F, KOWALSK[ ,. ~..' ' ' ' ' NOTgRY PUBLIC, State et flow YO~ . , ............. , No 52.4524771 (Signature of applicant) Ouahfmd m Stlliolk Coun~ Com~lsSlOQ Expires ~arch 30, 1~