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Home My WebLink About13419-z FOBM NO. S TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13419 Z Permission is hereby granted to: ..~.~.~.....~...~ ~ ..................... ..~~~....~..:~.: ....... a..~.~-... ...... ~ at premises located at ............................................................................................................................ County Tax Map No. I000 Section ...... ..~....OL..'] ...... Block .......... ..~. ........ Lot No ......... .~.. .......... pursuant to application doted ..... ..~.~......~. ............... , 19..~...~.., and approved by the Building Inspector. Fee $ ...................... Building Inspector Rev. 6/30/80 0 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~.~..~.., Approved. ~..~.., 19'~.~. Permit No.)..~.q. ! ~..-~. · . Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 orr 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 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 all applicable laws, ordinances, building code, Qho~tsing qode, and, regulp3tions, and to admit authorized inspectors on premises and in building for necessary inspections, f/.~,~ d~ '''i~i'g~ure~ant,~'n~a~;;~;ration)i~t"/a~ .~..~....... ~ (Mailing address of applica t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises./~.~..~' .... ~FX.. ~d. 0...~'. ......... ~ ~../'.~... f...".~?..~.., i~ .......... (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 ...................... 1. Location of land on which proposed work will be done .............. House Number Street Hamlet County Tax Map No. 1000 Section .... ~) .tr..'~/. .......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 .... /...~....~ ................................................ b. Intended use and occupancy .......................... ' .............................. ...... A. dd' ' ion/ 3. Nature of work (check which applicable): New Building .......... ltion .......... Alterat ......... Kepmr , ~.. .... ~ ..... · RemOval .............. Demolition ............. Other Work...t~ .......... : ' ~/'i,.~ ' -~ _ ,~ (Description) 4 Est~ated ost , '~ .~ . . F~a l~ . .~ - / . . ~ ~- ~if,~ . ~. (to be paid on filing this application) 5i ~fl~[~~ing baits ..... ~/~ ..... Number of dwelling units on each floor . : ~~...~ ................................................. ,,m ............ 6. If business, commercial or mixed occupancy, specty nature and extent of each type of use ... ~.4/~... g ......... 7. D~ensions of existing structures, if any: Front .... />~ ( ....... Rear .... /~? ....... Depth . ~ ~. ~ ......... Height ...... ~/ ..... Number of Stories . . ~ ............. ~ ............................... D~ensions of same structure w~th alterations or additions: Front ............ Rear ................. Depth .................... :.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............................... '. ......... f .............. 9. Size of lot: Front ......... f~.(. ........ Rear ....... .~ ~ ........ De~th : ~/~ ................ 10. [)ate of Purchase .......... ~ .......... Name of Foyer Owner .. ~~ ................ 11. Zone or use district in which pr~lseJ are situated ..... ~~ ....... ~ ......................... 12. Does proposed construction vioiate ~y zoning law, ordinance or regulation ..... ~.~ ............. 13. Will lot be regraded ....... ~.,.~.. ~.~ ...... Will excess fill be removed from premises: Yes ~ 14. Nme of Owner of premises ~': ~ ~ ~ ] ~ ~dress ...~. ~... Phone No. ~.~ ~.~..~. Nme of ~chitect .......... . ....~ ......~ ..... Address ...&~ z .~. Phone No ..... f...(~.. Nme of Contractor : Address Phone No PLOT DIAGRAM Locate clearly and distinctly alll 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. ,, S TA~ OF NEW Y K ' . . (~ame of individual signi~o~ract) ~ow n~m~ ..... i ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authored to perfo~ or have perfo~ed the said work and to m~e and file this application;that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work wffl be perfo~ed m t~e m~ne~ set forth ~ the application filed therewith. Sworn to/~before ~e this day of~~.'~ ~ 19~ .... ' ' · ,o. 5. .......... : .... 6aoS}zo ' " (~gnature of apphcmt) I NOfary Pub c In the State of New Resid n~ } ~uff ' COmmissio,1