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Home My WebLink About13604-z FOIIM NO. ~ TO~N OF SOUl'OLD BUILDING DEPAI~TMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 13604 Permission is hereby granted to: ....-zP~.,.~..~....~...~,~.~...a.. ............. ........ /.~..z.......~.~'~. ......................................... ,o .... fl ~. ~...~z......~ ~.~.~...~....~.. ~~ ? ..~ ~..~ ~ ...... ............ ~,,~.~=.......~~z~.C~~ .................. ~ ............................. o,p,,,,e,,~oted °t..;~ ....... ~..~.~....~.~.~ ........ ~.~ ........................ County Tax Map No. 1000 Section ...~,~..~.,.. ..... Block .....~...~... ......... Lot No...~,../..~'.. ........... pursuant ,o oppllcation dated ~..~¢/~............~.....~. .......................... , , .~...~.., and approved by the Building Inspector. / ~---~ Fee $ ........................ Rev. 6/30/80 ' ~:'?OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~. ~, .~ :. · ......... , 19 Approved .~..~..lff... ??. ...... 19 .~.. Permit No..//..~...~..~.~ Disapproved a/c ............. --s ................. (Building Inspector) APPLICATION FOR BUILDING PERNIIT INSTRUCTIONS Date ..... /t~./-~ .fi} ..... , 19 .~..c] a. This application must be completely filled in by typewriter or in ink and submitted 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 apph- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued 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 Building 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary i~i~)~~' ~ (Signature of applicant, or name, if a corporation) ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~r of premises..~-~-f~-.-~,..~...' .~9..WS. 'ff'x~: ! .~. · · .................................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized offi~cer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... .... License No Electrician / Other Trade's License No ........ f ........... 1. Location of land on which proposed work will be done.. ~(~[\.~..~, ..... ~d3~t&~.~-I., ~.'..~ !! .~ .~. ~. ....... ..................................................................................... House Number Street Hamlet County Tax Map No. 1000 Section In ~. ' .~..~.[[ ..... 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 ..................... ~.~: ........... ~ ........................ b. Intended use and occupancy .. ..... ~.~....Cf..c .//..~.... ~ .~..F2.¢./~/~., .. ..................... 3. Nature of work (check which applicable): New Building ..... ' ..... 'Addition..! .... Alteration .......... Repair .............. Removal .............. Demolition ...... ':,, ?..aOther Work ............... /f / ~.- ~ ! (DesCription) 4. Estimated Cost ......... ~ q~..o'-~0.. .... : .07~ ............... Fee .......... i ............................ "~ (to be ipaid on filing this application) i~n~mlit, s .o 5. If dwelling, number of dwell ............... Number of dwelling uni[s n each floor ................ If garage, number of cars . ./~.~'~ .~m .~..~)c~ ....................... i .......................... 6. Ifbusmes ,commercxaiorm~xedoccupancy, specify nature and extent ofeach tyl~e.ofuse .................. Height ............... Number of Stories. ~. ...................... ~ ............................ Dimensions of sam,q strpqture with alterations or additions: Front .... .~.~.. ~ ..... Rear. ~.~ ..c~. ........ Depth .. ...... '. · .~.(~-~'-'-~ ....... Height ........... ~. ~ ......... Number o4 S~to~es. eXw~4~<.. ............... 8. Dimensmns of entire new construction Front.. &0 ~C. .... Rear .... ~.I ~3~.... Depth . ~O,.a~. .... Hight ,,.Numbe of St ties ~ e ............. r o .............. ~c~[J~ Rea ...... ' ................... i ........ 9. Size of lot: Front ............ r ...................... iDepth .................... 10. DateofPurchase ............................. Name of Former Owner .i ............................ 11 Zone or use district in which premises are situated i ' ' 12 Does proposd t ti iol any i glaw di egulation: ' · e consruc onv ate zonn ,or nanceorr .... ............................ 13. Will lot be regraded ............................ Will excess fill be remove~ from premises: Yes No 14. Name of Owner of premises .................... Address ............... 1 ....Phone No ................ Name of Architect Address I 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 14, ~-~ ~ A s s STATE COUNT~ ...... · (Name of individual ~gning contract) above named. being duly sworn, deposes and says that he is the applicant He is the ~ ' (Contractor, agent, corporate officer, etc.)I of said owner or owners, and is duly authorized to perform or have performed the shid work and to make and file this application; that all statements contained in this application are true to the best of hi~ knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............ ~.-:~tay of. ~~ .... ,19 .~.~ ~ ~