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Home My WebLink About15554-z FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15554' Z Permission is hereby granted to: , ~ ~ /~ ~...d..~..~.....~..: ............ ~..o..~.~..~ .................................................. .....~.. ~....~..,..'A.:...L~.~.~ ......... to .~~.......~.'.-.,...~..~...~.......~......~.....~.. o, prem~ses,oco,ed o, ..... ~.~.~......~~ ................................... County Tax Map No.X"J 1000 Section ...... ..~..~....~ ....... Block ...... ,.~...~ ...... Lot No.....~.,...'~. ............. Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN HALL e-,OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ' ' (BuiFding Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 descript!on 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 Inspedfor'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 anypurpose whatever until ~ 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 o~ applicant) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ...................................................... .... (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 Phunber's License No ......................... Electrician's Licenie No ....................... Other Trade's License No ..................... .. -, 1. Location of land on which proposed work will be done .................................................. ............................................................... llouse Number Street ~ ' ' Hamlet Co nty Tax Map No 1000 Se tion Block Lot Subdivision ' Filed Mai) No Lot (Naule) 2. State existing use and occupancy of premises and in tended use and occupancy of proposed construction: a. Existing use and occupancy .................................................... b. Intended use and occupancy ...... , .... 7'' O£Work (check w I . . "'~$. Nature hich applicable): Now Build{ Repair ............... Remove[ . .. .-e .......... ,~-daiuon .... '~ .... Alteration ....... ...... - .... 4. EstJmatedCost.~.~ / ' ~ ~ ...... ~'~' ' ' ~ ' .... ' .............. Fee,, ED (Description ~ dwelling, number of dwelling units ,.. ' ~'.',* ~ "' 5. ' ~ (to b~ paid on filing this a lica' ugarage, numberofcar~ ~ ........... ' ~umberofd-,--,~ .- PP hen)' 7. Dn~lenslons of existinG stm~$ ........ 't }/eight ~ ,~us~S~ 1I any: ~'ront.. ' ' ............ ~ ~ ~ ' ' ..... "~a~ :' ' ~ ~ ~ a,. ...... Dnnenslons of sa e stmo,--L u f Stones ............ ~ , ' .... Depth .... m .-~u,re wliR~lterations or additions Fro~ ~ ....... Dep Dml~enSlons of entire n~o~ '- . --"'' ....... ~"' ' .............. '' "~' ' '' 8. ' ' ' ............... HeiSt ...... ' ' ' ~; ', ..... ~ ..... Rear, .. tfeJght ..... ~ ....... ~ ~ .............. ~umbor ogStoHes ,, ' ........... s~ chon: Front... 9. Size oflot: Front ...... aum~erofStoHes ...... ~ ...... Rear. ~ , ' ................. , ' ..... ..... ' ' Depth . 10. Date of Purchase ~ ..... ; ...... Rear .' ' .................. ' ....... : ~ ~ ' ' 'Depth .. ' .......... .......... 'Name of Fo~er Owner '' ~ ........ ,ll. 13. Will ~ot be regraded ...... ~ ..................... Will excess ~l bo remove from ...... ~ ............ N~ne &Contractor ~,.-;~:' ~ ...... :; .Address . ~v~7~ ~ ~ono No. , .~.T~.~ 15. Is ~h n ....... 2~.~.~.'.~c~..~ . a.~ .... ~'4 .... L ...... '...PhonoM~ , - Y , SouthoZd ,.~ ~ .... ~ a .ttdaZ r~..~ ,.. ,.. ~ ,~ :No. .~.,. Locate clearly and distinctly ;M1 build~ s' "' ' <' '. ,, '., ' :---' ',, ,,.-.:;,.~,,F;, ¢;~,~,', ......... ,, ,, property lines. Give street and bio~k numbe-~' y~ot~,~[ existing.or proposed, and. lad' . interior or comer lot. , ~ ,: ,r or aescnpuon acc9raing toAeed ann ~-..~ ~1 sot back ~oasions from NOTIFY E~Jtt,,D~NG DEPAP~ML;NT AT. ~OOG~ ~'~A~vil~(~ ~ PLUMBING 'COD~5 NOT ~S~NS{~LE ~R r~E~f(iN O~ CG,~STRUCTION ERRO~ STATE OF NEW YORK, COUNTY OF .................S~.S . ,, ,~,~ ~ ! ,.", ........ .4 ., ~,,~'~ ..... ,~'. rr.~.~ r/ " , ...... dH above named.!Name ofindJvldual signing contract) ..... b~h,s ly SWorn, deposes a~d says. that he is the applicant lie is the ... ~ ....... ~ ~. .... of sam owner or ownen, ~d Js duly ~ ontractor, agent, corporate officer, otC~a ........... ~ ,neats contained ~ t , workand 'to m~e' and applica ion; that all stat~ authorized to perform or have perfo~ed the id work wdl be aerie n n ,- .,.- -.... his application ar [r~ ~ ~est of his knowledge and belief, and ~ n e .... ,,,~ m~ ' . e the file this Sworn to before me this ' nor s~et forth m the application me~ met , , , , , that the ewlth.. ............ · ....day of..~,' ......, . ,, ....... H~LEN ~ PU~[IC, ~te of New York . ~ N0. 4707878, Suffolk Count~ ' T~m ~pi? Ma~ch BO, 19~ ' ............ (Stgnatnre of applicant)