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Home My WebLink About13388-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~3388 Z Permission is hereby granted to: ~...'35.~ ......... ~ ............... .P.. .............. ~..~ ........... .....%. ~....~:~.:.....!.!..~.~ County Tox Mop No. '000 Sectjal9 ..... ~-.5,kJ(, .......... Block ........ ,~, ........... Lot No ........ ~ ............. '0 application dated .~.t:~,~....~.,....;~....~.. ................. , 19.~..~.., and opproved by the pursuant Building Inspector. Fee $... !..~../..~.. · .'~, ...... Rev. 6/30/80 "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-180:3 ~pproved ...~..~...~.~..., 19 .~.~ Permit No. J .~..~..'~..~... ~isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PER~/IIT Received ........... ,t9... Date .................. ,19.. INSTRUCTIONS a. This applicatio- must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate ~[ot plan to scale. Fee according to schedule. b. Plot pla. n shox~:~g location o.f lot and of buildings on premises, relationship to adjoining premises or public streets )r areas, and g~ving a ~.etailed description of layout of property must be drawn on the diagram which is part of this appli.. :ation. I , ' c. The work coveked 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 ;ball 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 '.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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspej;tions. (Signature of applicant, or name, if a corporation) ..,:ff.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ............................................................................... Name of owner of premises .~.<//fq...~.'....,~..ff.v:.~.~.r..~.'~. ~.. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate 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 Number 'Street Hamlet County Tax Map No. 1000 Section ... L..~..tT(. ....... Block...i.~. ............ Lot....Z/f. .............. 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 ..................................................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair '. Rem6vai Demolition Other Work ........... .......................................... ~_. ~ (Description) 4 Estimated Cost /.?..~. ......... Fee ............................... '" (to be paid on filing this application) 5. If dwelling, number of dwelling ~ ~nits ............... Number of dwelling units on each floor ................ It' garage, number 6f cars ........................................................................ 6. If business, commercial or mixec occupancy, specify nature and extent of each type of use ..................... · ' ' if any: Front Rear Depth 7. Dimensions of ex~stmg structures, ........................................... Height ............... Numlber of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth i Height ' Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Number of Stories Height ............. >'V'r i ' ............. ~.. ....................................... 9. Sizeoflot: Front ........... ~ ........... Rear ..... ! ............ DeEth .... ..~..v...~ff..o ...... ~/2. ~ ' Name of Former Ow~ Z~,,,~ ~ ~0. Date of Purchase ......................... let ............................. : I. Zone or use district in which prqmises are situated ..................................................... :2. Does proposed construction viol'ate any zoning law, ordinance or regulation: ...d( 0 ...................... 3. Will lot be regraded ...... At(0. ..... , ............. Will excess fill be removed from premises: Yes ( 4. Name of Owner of premises ~v/dc~{4 t-.o. .......... Address~ ~..'~. [...~:..'~,~,0 77..~c' .... Phone No..Z.~.J'. 7 .~.~.O.'..~.. Name of Architect .......... i ................. Address .... .~. ~f...'~. ? :~dl? q¥. Phone No..5~f('.W.-..4,:.{~.2.. Name of Contractor Address Phone No PLOT DIAG1L~dVl Locate clearly and distinctly all;1 buildings, Wheflmr existing or proposed, and, indicate all set-back dimensions from )roperty lines· Give street.and block number or description according to deed, and show street names and indicate whether nterior or corner lot. I~>c~t U 'xroc~Jr ;TATE OF NEW vqg, K ;OUNTY OF. (~.f;YP...c...... !S.S 2' '//~/'P'* Z~' . ./2/, .~.'~..q~.'.~.'9... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) bove named· , agent, corporate officer, etc.) ~f said owner or owtkc)s, and is duly antl!orized to perform or have performed the said work and to make and file this ~pplication; that all statements contained m this application are true to the best of his knowledge and belief; and that the .york will be perfonne~an the manner set forth m the apphcatmn filed therewith. ,worn to before me th~ ' . .. .... 19..r.'r ......... .... : dayo .. ...... , .~.~~" ~,dW ...Countv ~otary Public ........... .... ................ NOT~R¥ PUBLIC. Stale 0! New Y0,k --~ (Signature of applicaet) No 4707R78, , l~.Ii~l£~plres Ma~¢h 30, 19~'~