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Home My WebLink About12956-z FOB~ NO. ~ TOWN 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 ,~,UTHORIZED) ~ z ~o,~ ....~..~....~ .................... , ,,.~.~ Permission is hereby granted to: /'~/I ....~.~...~~ .................... ~. '~.....~.....v. ~ ...~.. ...... ~ .... ~ .... .' ~';'i .............. ....... i~ ........ ~_~....~..~.: ............. ~.J ....... I'0 I '? ~ .... ~~.~....~..~..~...~...~:~.~...~..~.~......~....~.F~...~.. at premises located at ...~...~.....J~.~ ..~.M~....~...,~.....~-~-.~..~......~....~...~....-.-~.~...~/~..~ County Tax Map No. 1000 Section ..... .~....~.....~.. .... Block ............ J ......... Lot No ...... L.~..'~.. .......... pursuant to application dated ....... '..~.~..~.J ................... , 19..~...L..[, and approved by the Building Inspector. Rev. 6/30/80 'FORM NO, 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:2 ixamined., j~..Ck,.,~ ff, I .~.~ .... 19~. ~. ~pproved . ..'Dq .a~..dq..~..., 19 ~'J. Permit No. j.'.~.9. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buitdings on premises, relationship to adjoining premises or public streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ,hall 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 ;hall have been granted by the Bl~ilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit auth°rized inspect°rs °n premises and in building f°r necessary inspT~,2~(~5-~.' /~ ''' i~'g'' t~ure'~oof appli~fint, or name, if a c~;' ~a't'(~)' ' ~' gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. %,neofownerofpremises ~.Z~. Z.~.~'-/'~ ..~. '~. '~' ',ff.~'/~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 ...................... I. Location ofland on which proposed work will be done. ~_~e¢....~...,~..'.. ,~. ,dd~.~..~ . .-:-T,. .~... ~. ~ ttouse Number Street Hamlet County Tax Map No. 1000 Section ..... ~.~. ~,: ..... Block .......... ~ ....... Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~. E~isti,~,se ~nd oc¢,,pan¢V . ~g .~ ~ .~ ............ -~ ..................................... an, ............................ (Nature of work which applicable): New Building ' ..... Addition ......... Altera~n. ~. ~..~ ...... (check Repair .............. Removal .............. Demolition ........... :... Other Work ."~ gt~ ..... ~-- ,, ! (DescrilJtion) Estimated Cost ~ ,.5~. · ·~ ' "' (to be ~aid on filing this application) 5. If dwelling, number of dweiling 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 .................... Rear ' Depth 7 Dimensions of existing structures, if any: Front ...................... ' ..................... Height...............NumberofStories ............................ ........................... Dimensions of same structure with alterations or additions: Front ' Rear _o$ s)o 'e ....... ~ Depth ...................... Height ...................... Number n s .............. ( i.~ Dimensions of entire new construction: Front ............... Rear. ~.. · _'t~' ' '/'" ~epth ....... : ........ e~ght .......... umYb'cnm~ ~ ~. O ........................ ( " lot Front ..................... Rear ................. iDepth .... 9. Size of ........... of' P rch Name of Former Owner ~. ~;te u sase .......................................................... 'strict' wh'chp' ' 'r situated .......................... ne or use 1 in 1 lemlses a e ..... ' ........ i .............. Does proposed construction violate any zoning law, ordinance or regulation: .... 1 ............................ .W!II lot be regraded ...... ..... .............. Will exqess fill be remov%t fr,,om premises: Yes No Name of Owner of premises~./.~4:...' ~ ,~. #.~..~..,f!~. Address/f~./,.~.~?g,gjo; e~.. ff..d(.. Phone No..7o/.15'. Name of Architect ........................... Address ............... i ....Phone No ................... Nmne of Contractor .......................... Address ................. Phone No ................ Locate clearly and distinctly all buildings, whether existing or proposed, and. ifidicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and mdmate whether nterior or corner lot. 3TATE OF NEW YORK, S.S 2OUNTY OF., ........... ..,. ~.. ......... " .. v~/~ ................... being duly /~individual signing contract) there named. sworn, deposes and says that he is the applicant (Signature of applicant) le is the ................................................................................ (Contractor, agent, corporate officer, etC.) ff said owner or owners, and is duly authorized to perform or have performed thelsaid work and to make and file this q)plication; that all statements contained in this application are true to the best of l~is knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this qotary Public, . ........ County HELFN K, DE VO£ '""" .... NOTARY PUBUC, 8~aIe of NoW York No, 4707878, ,%ffolk Co~nt,~ Zcrm,E~p~ms