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Home My WebLink About13118-z FORM NO. B TOW'N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) I/_~ County Tax Map No. 1000 Sect,on ...... mu..~, .......... Block ...................... Lot No ......... ,...~. ......... pursuont to application dated ....... ~....~...~.~.4' .!'.~ .......................... , 19.~!:1.., and approved by the Building Inspector. '~ ......... : ...... L...:..~ ...... ~:...:.: ........... :..!.~ ........... Building Inspector Re~ 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1802 Examined...! i.0. .... Approved .~.0.., 19'~ .~. Permit No. ] .~.], ~ ?~.. 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 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 tkis 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 admit 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. Name of owner of premises .~..:. ~.. './~./:q5...?)~ {~' .:5... ::P./:: ::'O .................................. (as on the tax roll or latest deed) If applicant is a co~ora~n, signature of duly authorized officer. .... .......... (Name and titlo of co,orate officer) Builder's License No. ~ ~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ........ ~. ..... Block .... 4 ............ Lot.. ~ ............. Subdivision ..................................... tied Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . . ~. Ex~stin~ use and occupancy ...... Z :~ :. ....... ~ ............. $ ................................ ...... .................................. 3. Nature of work (check which applicable): Repair .............. Rem!oval .............. 4. Estimated Cost ............ ~ .................. New Building .......... Addition .......... Alteration .......... Demolition Other Work (to be paid on filing this application) 5. If dwelling, number of dwelling, units ............. Number of dwelling units on each floor ................ If garage number of cars Ifb in ' ~d ify htyp 6. us ess, commercial or mix occupancy, spec nature and extent of eac e of use ..................... 7. Dimensions of existing structurbs, if any Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... i. · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth ............... mb ' Height ............... Nu er of Stories ...... 9. Size of lot: Front ........ ~,~ / .... 2'~~''' ......................................... ............. Rear ........... Depth .................. 10. Date of Purchase .......... ;~ ................... Name of Former Owner ............................. I 1. Zone Or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ~_~'~,~¢,~,~. ¢'htc~,C~gg~,~... Will excess fill be removed from premises: .Y...es No 14. Name of Owner of premises ~.././74) ~,~..~. A dress ~ · :. · ~ .... d ..... Phone No.."7'. ............ Name of Architect ......... 1 .................. Address ................... Phone No ................ Name,of Contractor ........ i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether corner lot. b" "- CY' L):G. L, FEE: )_. : ....... 'D-~-p~-'-~ENT AT NOTIFY BUILDING 765-1809 9 AM TO 4 PM FOR THE~ FOLi. O~UlNG INSPECTIONS: I 1. FOUNr~ATION ' TWO REQUIRED FOR Pr}UP'ED CONCRETE ~ 2. ROUGH - FRAMING & pLtJM~ING 3. I1'JqJI A'''mil ~UST 4. FIh/q - BE C .,?-,I ¢TF FOR C. O. ALt. 601'Et'tm ~(TION SHALL MEET THE P.E'~' 'm~MFNTS OF THE hi. Y. STATE CoNCTRUCTION & FN~RGY CODES. i NOT RESPONS!BI r,i FOR,. coUNty .... laS .... ~ .... ~/~'/..¢..~ .t~-~ .~ ?: ........ being duly sworn, deposes and says that he applicant ............ ' . (Name of individual signing contract) above named. is thb ..................... : ..................................... 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 contained in this application are true to the best o.~_ledge and belief; and that the work will be performed in the mannelr set forth in the application filed therewith. Sworn to before me this $ U i -- ~ ~ blic ...... ~..;.~ ..... ~.~~'X~ounty ~ ~ /I [~i~/ ELIZABETH ANN ~;i~'NEVILLE 'o'~ New York (Signature ~ X_H6. 52.8125850, Suffolk i Terr~ Expires March 30,