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Home My WebLink About13069-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .~,~~...~..~ ................... ~o ..... ~~ ........ ,..~.~ .......... ~.: ......... ~..~~Y ~..~~ .... ~<4~.~ ~q~ ..................................................................... ~, ~.,~,,,, ,~,~ ~, ....... ....... ~~~e~.~ County Tax Map No. 1000 Section ...l.~,..~,~,] ......... Block ...... ~,,~,, ......... Lot No ......,/,(,.::.,,~.~,~, ..... ~u..o.t to opp,,cot,on dot., ..... ~f~.,.~ ....... .?.. .............. . ,d./.~ o.d opprov., by ,he Building Inspector. Rev. 6~30/80 'Building Inspector .Sown of Southold Town Hall 'Southold, NYl1971 Enclosed .pleas, e f~nd bu.~ld~ng pem~t No,~YlSQ69 Z obtained for constzmct~)-on o£a fence% G0n~truction! of the .~ence h~ been completed,. ~1~ ~s~i~:ca ,'~tifi6~%e of .occu~ncy at your e~l~est con, enteric *' Th~nk you very much ~or ygu~ 6o0per~ioh. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 1319811 'b Received ......... ,q9... 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 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 shah 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 reguhtion_s, and to admit authorized inspectors on premises and in building for necessary inspections. -- ,/,, c57 (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. Name of owner of premises ....~/.~.~..2~ .~..~.-... ~f..7~..:~...~.w...~... ?..,~./~.... ~.~...~.~. f~.,0..~..~.~.o :~f. ........... (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. c"4""~ °~ 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-,~/~/0u,]~.~'' Street / Hamlet County Tax MaffNo. 1000 Section ...... ~ .~ .......Block /0 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 ........ .~./.J.~ ~d~.. ............ ~/../~....~ ............................ b. Intended use and occupancy .~./p?. . ..~. .,~.44X. ~. . /..~:2~. .'~. .~ ~ . ' ~ Repair .............. ~Rerqoval .............. Demolition .............. Other Work..d?.~.'q.c. ( .~.~. .... i .lq;-~,~._ ~ (to be paid on filing this application) 5. o, W~llmg' units ............... Number of dwelling units on each floor ................ If garage number of cars 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 ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new consFruction: Front ................. Rear ............... Depth ............... Height ............... Number of Stories .......... 9. Sizeoflot: Front ... /./?.' Rear ....... ./?...~. .......... Depth .... 10 Date of Purchase ~ Name of Former Owner 11. Zone or use district in which premises are situated , ............................................... 12. Does proposed constructton wolate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ;~'i ....... ~..t .......... Will excess fill be removed from premises: Yes No 14. Name!of Owner ofpremises~.~./q .~?/.ed¢.X4. o.¢ Address ¢/~' Name of Architect ' Address Name ~of Contractor ........ [ .................. Address ................... Phone No ................ Locate clearly and distinctly all property lines. Give street and blocl~ interior or corner lot. PLOT DIAGRA~M buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether . .~./.~...~.~....../~.~../(.q./J.A~. r. '.~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signling contract) above named. He is the ...... ./~,, .~/.~J'.~../..-~. .... i ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 his knowledge and belief; and that the work will be performed in the manne? set forth in the application filed therewith. Sworn to before me this ' ............ /..%9... ........ day of ........ ~..., 19~..)~. Notary Publio, State Of New ¥0~[i ~ ~ .......... No, Bl-Oa4455a Suffolk County(/'('"'- (Signature of applicant) Comnd.lon EX~t~ March ~0, I$~r~