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Home My WebLink About13333-zTOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13333 Z Permission is hereby granted to~ , , ~.~ · ...~.~...~...,~.....Y.~.,~ ............. .~.~....~.~.~.~..~: ....................... ~...~.~...g,..~.........o..a...~..~..~.. ........ .................... at promises located at ....~....~...~... ...... ~.,~.~.....~.~....,.~.~ ........................... County Tax Map No. 1000 Section~.~.....O.....~.....~. ..... Block ........ .~ ............ Lot No ......~./. ............. ./ pursuant to application dated .... .~.,4~,~.~....o..~ .............. , 19.?...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'X 'Z. L~ ' FORM NO. 1 ToWN OF SoUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~pproved .X~,~ .']..., 19~fi.. Permit No. ! .~..~.~..~. '~-' · )~sapproved a/c ...................... "~ .... - .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,, TOWN OF SOt/I}IOLD , Date .. ~.~. ............. 19 .~..~ iNSTRUCTIONS · ' must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a. This apphcatlon ..... ~ Fee according to schedule. · ....... ~,,;.,in, nremises or public streets sets of Ppl~on:,~u~toewPinl~t lPotcaa~:~/;~'~.ot and of bmld~mg~o~r~emm~se?;~e~rt}~Snolnp ~e~~' ~vhich is part of this appli or ~;as, an/giving a detailed description of layout o~ p P cation· mmenced before issuance of Building Permit· · this a phcatlon may not be co · · 'ldin Permit to the applicant. Such permit c. The work covered by. ,.P ..... n,ildine Inspector will ~ssued a Bm g d. Upon approval of th~s appucauon, m~ 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 t!~e issuance of a Building permit pursuant to the described. Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Building ode, and regulations, and to Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as-herein admit authorized inspectors on pre ' -~... ff....6~.~. ................... (Signature of applicant, or name, if a corporation) " ......... (Mailing address of applicant) " 0 7cf/- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /~o~,-~ ~ ~./(/.~fi ~'//"~'~ ...................... (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 ......................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............... - .... · ? 4'7 c e,-' ............. ' ' , Hamlet ............... Street House Number · O o~ 6 Block .... County Tax Map No. 1000 Section .................. .......... Filed Map No ............... Lot .............. Subdivision ................ (iq'a~) .... - occupancy of proposed construction: 2. State existing use and occupancy of premises and intende use and .......... , ................ ,,~c,~./~/r,,yce' ~ . .,,.. , ............. a. Existing use and occupancy ................. b. Intended use and occupancy ,~c'4'~ /?c e' .~. ~a,t¢~.?. ............ 3. Nature of work (check which a )plicable): New Building ..... ' .....Addition.. ~ ..... Alteration .......... Repair .............. Rem oval .............. Demolition .............. Other Work ............... . ?../~..~. ; ~.}.~ ~ (Description) 4. Estimated Cost ............................... Fee .... · ............................... ~' (to he paid on filing this application) / 5. If dwelling, number of dwelling! units ............... Number of dweiling units on each floor ................ If ggr,a, ge ggt3,.~_ ~o~f cars ............ /. ................................................ b~ihC~o~tt~:,m~'~t~ loccupancy, specify nature and extent of each type of use 6. If 7. m~,l~~.,~ ~,~:o~q~ any. ............... .............. Depth ............... Front Rear I-Iei~t~'~' '~}!...~.~...,.~, ....... ~u3 ~er of Stories...~ ......................... · ' ' · " ' .......................... Dhn~4~n,t~ ~e's~ur~ halterat~onsoraddmons:Front ................. Rear .................. ........... ~.~.lit . Height ...................... Number of Stories ...................... ' 8. Dir~ensi~r~m*'~'h~"Z~6~c ~s*Jt ction: Front ............... Rear ............... Depth ............... · er of Stories ........................................................ 9. Size of lot: Front .......... ! ........... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner .............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name :of Owner of premises .. '. ................. Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al 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. ' STATE OF NEW Y~ S S COUNTY OF .......... / ~/ ' (Name of individual sigh'ina contract) above named. ·. being duly sworn, deposes and says that he is the applicant He is the ..................... i .................................................................. ,' (Contractor , agent , corporate officer , etc . ) 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 conthined in this application are true to the best of his 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 : ............ ~. ~ ...... day of.....~4~.. · HELFN ~, DE VOE NOTARY PUBLIC, State of New Vor~ No. 4707878, Stt!fo)k C0UlIfW ~ ~ : ' I~rm [~lres ~ar~h 30 19~ .......... ,19 ~.7 ~' ..... County "-. (Signature of applicant)