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Home My WebLink About11149-zTOWN 0~ TOWN- HALL SOUTHOLb, N. Y. BUILDING P,ERMIT (THIS PER/VtlT MUST BE KEPT ON THE PI~EMIS~S UNTIL FULL COMPLETION OF THE woRK AUTHORIZED) N°. 11149 Z Permission is hereby grar~ted to: ~t premise~ located at ..................................... t. .........................~ '~ .................... ~ ~ 19..~..~ and a roved b the Building Inspector. Fe$ ....... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined./l~/."~7. .(..tTg. .... ,19~../· Approved . .~..~..~.../. ?.. ·., 19¢?. Permit No..(4. Disapproved a/c .................................... ./ APPLICATION FOR BUILDING PERMIT Application No ............. INSTRUCTIONS a: This application must be completely filled ~in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed descriptiou of Iayont of property must be drown on the diagram which is part of this apl: cation. c. The work covered by this applicatmn 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 peru. shall Ue 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permi. t pursuant to t Building Zone Ordinance of the Town of 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 describr The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. .......... (Signature of applicant, or npme, if a corporation) {Mailin~ address of applicant) State whether applicant is owner, lessee, agent, arcbite'¢t, engineer, general contractor, electrician, plumber or build. ..... ........................................................................... ................... , ...... : . . ....... Name of owner of prentises .~.l'/.x ~ t'o- k~q.. ~L ~.q O~ .... /'... t J~.l .c. (as on the tax roll or latest deed) If applicant ts a co~poration, signature of duty authorized officer. (Name and title of corporate officer) Plumber's License No... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ............ ..... House Nmnber Street tlamlet County Tax Map No. 1000 Section ..... .O.7..D ........ Block .... .~.~. .......... Lot..~./. ~. .......... Subdivision .................................... '. Filed Map No ............... Lot .............. (Name) 2. State existing use and occnpancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~./~. .... ~.. ........ ,; ..................... b. Intended use and occupancy . .~. ~.~'.-..~...~~~. '.~.- .................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair ............. Removal ........... Demolition .............. Other Work. Itl ~ql( ,.c,..~'~.,~.. (Descn'/otion) 1. Estimated Cost ' (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 ..... : ................................................................. 5. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structure~,ifany: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... i. · Height ...................... Number of Stories .................... L Dimensions of. entire new constrnction: Front ............... Rear ............... Depth ............. Height ............... Il/umber or' Stories ......... ... ...... ). Date of Purchase ... ['}:¢_.h.~.c~F. gJ.q-~].: .......... Name/of Former Owner .-'-~. l".&..al.~.: .~..& .~.[.~. I ....... 1. Zone or use district in which premises are situated .................................................... L Does proposed construction violate any zoning law, ordinance or regolation: ............................... I. Will lot be regraded ............ : ............... Will excess fill be removed from premises: Yes No [. Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect .......... i ................. Address ................... Phone No ................ Nzone of Con~acto~~ . ........ , .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ,all buLidmgs, xvhether existing or proposed, and. indicate all set-back'dimensions from :operty lin~s. Give street and block humber or description according to deed, and show street names and indicate whether ~ter/or or corner lot. .... ~~, .~..t .... '.~~ ...... being dtdy sworn, deposes and says that he is the applicant (Name of individual signing' ' '~"eoon~¢t) 5ov¢ named. e is the .................... ~ ...................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is dul~ author/zed to perform or have performed the sa. id work and to make and file this pplic;,tion; thal/all statements contfiined in this application are true to th~ best of his knowledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this