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Home My WebLink About13274-z IPOBH NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y, BUILDING PERMIT FI'HIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1327~ Z Permission is hereby gronted~: ~ /~/~ ..~..~.....~..~...~.~ .... ...... ................. ...~.~...~.:.~:.....u...~.~.~_.. ~ ~o ....................................................................................... ~r-£ ............. ot premises Iocoted of ....)..[~.....~......~~....~.....~ ............ ~.~.~..~ ............. County Tax Map No. 1000 Section ..... ]..,.~.,.,~, ........ Block ....... ~. ........... Lot No ...... ~..,~. ........... ~/-- Building Inspector. Fee $..~.......; ............. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined..~4~J (-o., 19~..t[. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ,19 Date ................... 19... INSTRUCTIONS a. Ttds application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 7 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 street' 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 permi, 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 Occupanc~ 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 thc Building Zone Ordinance Of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o. 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 t( ~a_~in~t authorized inspectors on premises and in building for necessary inspections. (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. Naxne of owner of prmnises...d..~..F~..... ~..~ .rl.~..T ..... . .~....0~..~.~..~.~.. ............................ (J (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 ...]...~ .~. ........ Block ...... .~ ......... Lot ~...~..~. '.. 4~-~-..q~.~...~.'/.~T~ ............. Filed Map No. · .'~.7 ......... Lot t?//~/2/.c~ ... Subdivision... (Natme) ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use a~d occupancy ........ . .~..~. £~ .... .~. ,.-o. ~..~./~. ~. ..................................... b. Intended use and occupancy ...... .~..,~/m.t. 7"' '~' '~' ' '~'/'/'/'' '~ '~ .................................... o 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... 'Addition Repair .............. Removal ............ Demolition ......... Estimated Cost : ....... If dwelling, number of dwelling units. ....... 2dteratlon~, ..... ... .. Other Work.../':~. f..~.-'.. (Description) Fee ~' (to ble paid on filing this applic'ation) ........... Number of dwelling un,ts On each floor ...... . .......... property lines. Give street and block number or description according to deed, and shbw street names interior or corner lot. If garage, number of cars .......................................... ~ ............................ If business commercial or mixed occupancy specify nature and extent of each t~pe of use Dimensions of existing structures if any: Front Rear i Depth Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ' Rear Depth ...................... Height ...................... Number 0f Stories .................... Dimensions of entire new construction: Front ............... Rear ...... i ........ Depth ............. Height Number of Stories Size of lot: Front ' Rem' ' Depth Date of Purchase Name of Former Owner ~ Zone or use district in which premises are situated ....................... ~ ............................ Does proposed construction violate any zoning law, ordinance or regulation: .. i ............................ Will lot be regraded ' ' ' Yes Nc ............................ Will excess fill be removed from premises: Name of Owner of prenfises Address ' Phone No Name of Architect Address 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 and indicate whethe~ STATE OF NEW YORK, COUNTY OF ...... S.S ................................................. being duly sworn, deposes and says (Name of individual signing contract) above named. that he is the applicant He is the .......................................................................................... , (Contractor, agent, corporate officer, etcD of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of h is knowledge and belief; and that the work will be performed in the manner set forth tn the application filed therewith. Sworn to before me this ~, ........... o {~ f / i ~.~gnaguro el appficant)