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Home My WebLink About13465-zTOWN OF SOUTHOLD 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? 13465 Z Permission is hereby granted to: ~ ~ ~~~ ../~~. ' ~, . 1~ ~,,'-'7 ,~,~ ~z~-~t,~ ~ ~~ ~ ~....~..~... County Tax Map No. 7000 Section ....~.,~...--I.. ..... mo~k ....... ~...I ....... Lot ~o ..... ~.!..~. ........ pursuant to application dated .......~.~'..dlk3:x3..LL~....~...~....., 19..~....~., and euildlng Inspector. Fee $...J....~....[. .......... approved by the Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .q).~fi~'~¢...~...', 19~.~.. Permit No. l .~.. ?/.¢ .&.'-..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date INSTRUCTIONS a. Tkis 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 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, housing code, and regulations, and to admi~ ~isesandinbuildingfornecessary~......~..,...~..~ .......... (Signature of applicant, or name, if a corporation) /~../.e.~5~ ?..C.~.~ .~... ~.,¢../...~;.¥.~.~... .[ _ ~"'"'" ~.~,,,~'~D~EPm~T'OLo (Mailing address bf applicant) State ~;hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~me ofownerofpremises..~p~ ~.~//.. w...~.~ (..*..'t..../?.,f..z2~ ./~.~.. .......................... (as on the tax .roll or latest deed) If applicant is a corporation, signature of duly authorized officer. /~ '~ ~ /~. ' Builder's License No .......................... ~"-~ /~O/~-0 /~ ..~ //tz/C--t~' Plumber's License No ......................... /]-/I,///,t/~L ff~-/v'd.~- /O,/ZO Electrician's License No ....................... j~/VT-//'2-~- ~/z ~.OF<~ ~ Other Trade's License No.... ..... ... ....... ...'L/)"vD ' £o"r t' ,.,eo~v,4~,'e'ZJ p 1, Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section did oZ. ¢ Block 0 / Lot 0 / 0 Subdivision ....... /-/.~. :~./..eT./g. ................. Filed Map No..7.'-..~.*.: Z~... ~ot../.-. ~ :.4.: ~.. (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 ~'~/~ ~/~'~ Natur~ of work (check which applicable): New Bu~Idln8 ....1¢~.' ..... Addition Repair .............. Removal .............. Demolition ..... ;. Estimated Cost 5. If dwelling, number of dwelling units ........ If garage, number of cars ........................................... : ................... ! ...... 6. If business, commercial or mixed occupancy, specify nature and extent o'f each t~pe of use .................. 7. Dimensions of existing structures, if any: Front ............... Rear ...... I ........ Depth ............ Height ............... Number of Stories ........................... i .......................... Dimensions of same structure with alterations or additions: Front .... . ...... j ...... Rear ............... Depth ...................... Height ...................... Number Of Stories ................ ~ ......... Alteration ........... .t .... Other Work ..... ; ......... (Description) ........... Fee ........ : ............................. ~' (t b~p ' ' gth' ppli ) · o md on fihn ~s a cation ...... Number of dwelling u~its on each floor ................ ' 8 Dimensions of entire new construction: Front Rear i Depth Height ............... Number of Stories ........ ! ' ' 9. Sizeoflot Front ....~.~..3/.~. I~ d"~'~0 ......... ~,;~"~j~z~.~ ......... 10. Date &Purchase O~:r~'~.';~t, ~'am .... ' ~'L&7'~/¢-/1,*¢ ' ' .................... ~ e o~ rormer uwner i .......... : ~: .-~ ............ 1 1. Zone or use district in which premises are situated .... ~...6~. ! ~",,¢~ .~ I ' ' 12. ' ........................ ' ........ "' " Does proposed construction vio~l, aKe any zoning law, ordinance or regulation: ! . t~'.~. .. 13. Will lot be regraded t'~'c~ . ' .......... . ......... ' ...... ...... . ................... Will excess filkbe removed from premises: Yes ~ 14. Name of Owner of premises ~/?.~,../f../¢..~./..~ .... Address ./'fl?../¢'.~, .//.~..I~..~.4... Phone No. [~&3.:a.~...~..~. Nmne of Architect ........................... Address ............ j. . Phone No ...... Name of Contractor l~.+E'~., f~..~.F'~./..C~.~ ........ Address /Gt'a ~r~)t:CC-~rg~ ............. .... · ....... :'/.c; 7: .... Phone N~ ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. ihdicate 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. -'~'~'~' i rtl! ... _ i ' L, STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signing contract) above named. ........ being duly sworn, deposes and says that he is t applicant (Signature of applicant) He is the ............................................................ i ............................ (Contractor, agent, corporate officer, otc0 of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make ahd file this application; that all statements contained in this application are true to the best of h s 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 O~ .... · ......dayof ................ 19~. Notary Public,.... ~¢g~......%:..~).~.. V~. ........ County ttEl.~N K OF goE NOTARY PUBLIC, Sta~e el New York No, 4/07878, Suffutk Oounty ~