The URL can be used to link to this page

Home My WebLink About13414-zTOWN OF SOUTHOLD BUILDIHG DEPAX~TMENT TOWN HALL $OUTHOLD, N. ¥. BUILDIHG I'EI~41T (THIS PERAAIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK .A. UTHOP. IZED) N? 13414 Z Permission is hereby granted to.: / ...-- :-.,,._ , :::::::::::::::::::::::: ...................................... ..~......~..:.~..: ...... ~.]...?...~..(~ .......... at premises located at .. ,'7..,~, ,~.,~, ~: ..... ,~..,C~ .~;~ . ,,,~,.~ . Building Inspector. Fee $...,~.,.!, .............. and approved by the Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT ,( TOWN HALL O ~~~'~ ,, ~oOUTHOLD, N.Y. 11971 TEL.: 765-180;~ Examined · . ~.., 19~.~. Approved .~,' .......... 7 19~,~. Permit NO./. ~.q ! .q...~,. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .................. , 19... INSTRUCTIONS 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 par[ of this appli- 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 authorized inspectors on premises and in building for necessary inspections./~ , ' · . (Signature/o~/applicant, or, amc, if a. corporation) ·. (Mailing address of applicant) ///'28~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name' of owner of premises ~ .0/~...~. ~ .................................... (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 Iicense No Electrician's License No ............. : ......... Other Trade's License No ...................... 1. Location of land on 7hich proposed work will be done... 7. · ......... ........ ......................... House Number Street ........... County Tax Map No. t 000 Section ..~..7.~.. ......... Block ..~. .............. Lot../...~...fl-~..-.......... 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 ....~_. 4~ ............................ b. lntended use anti,occupancy ...................... _ ........................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration, f..: ....... Repair .... .......... Removal ............ Demolition .............. Other Work. ,~,~ .... i (Description) 4 Estimated Cost ~' Fee i ~" (to be paid on filing this application) $. If dwelling, number of dwelling ~nits . .~ ....--~-'~... ...... Number of dwelling units on each floor . . .r-~-Z~. . /. ........ I! garage, number of cars . . .~, .............................................~' ' t 7' '_- ~"~'" ............ 6. 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 ............... Number of Stories .. 33,. ................................................... Dimensions of same structure w!th alterations or additions: Front .... -., .......... Rear '..'~-~. .............. Depth.., .--rv~...- ............. ~.. Height .................. Number O ries., ~--~-.~.--;t_,.~..._~,.-,~ ......... 8. Dimensions of entire new eonstructmn: Front .~...-:--:-:77.. .. Rear ............... Depth . Height ~ ........ .. Number of Stories ,~,'". ............................................ 9. Size of lot: Front ,5~ .... ,..~..i .......... Rear .... /. q).2) .............. Depth ~,/.%.'~. ~ ................ 0. Date of Purchase .... .......... Name of Former Owner .... :... : 1, Zone or Re district in which pr~m~ses are situated .~¢~_z7~ ............ / ....... .~.... ? .....~ ........... ',2. Does proposed construction violate any zoning law, ordinance or regulation: .~.~ .... .~i...'~. ........... 3. Will lot be regraded ...~'~L): 'i ..... ,:...,,.. ~, .......Will exces~s fill be ren:4v~ed f~or~p~lni~.;v,~,,,..~Yes No 4. Name of Owner of premises .~i0~q .~.~... (,~dress . .~. ~.~tO~'[.~ .(..~.. fPh~one~'~.... ~-~'~ ~.~, Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... 1 ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from ~roperty lines. Give street and block aumber or description aC :ording to deed, and show street names and indicate whether nterior or comer lot. xq ;TATE OF NEW YORK, ;OUNTY OF ................. ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. Ie is the ...................... i ..... ............................................................. -. ~ (Contractor, agent, corPorate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained ha this application are true to the 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 ............. ~9..~.....dayof .... ~ ............ , 19 ....... .cou ....... ty ,~. ~o ~10l~/a. s,~t0,!, amtv (Signature of applicant) 37759 b ./ Z