The URL can be used to link to this page

Home My WebLink About14706-z FORM 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 AUTHORIZED) N? 14706 Z Permission is hereby granted to: ..... . .~.~.~.c....~l, ...... .~..~..~~ ..... /~..~.~.-......~.~.z~z~.~.....L~.~ ...~..~~~.~..~...~.~ ............ ~ .......... ~.~.~.~..~.~......~ ~.~.~......~.~ ................. .... ~.~.~.~.....~.~ ....... ~....~....~....~.~ .......... ~.....~ ~ ~,~ ~ed ~ ..~.~.~ .......... ~ ................................................................................ ......................................................................................................... ~~.~.~... County Tax Mop No, 1000 Section ...... ./ ..............Block ~ ~'' Lot No. (~/~ pursuant to ¢Jpplication doted ........ ..~....,~..../~..~J, ........................... , 19 ........ , and approved by the Building Inspector. Rev. 6~30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved .... ........... .¢ ...... J "' 7 - '(~'"";Ji-'-'fI"-'f-::tL'-(Dm~u .g n~p~c m, ........ APPLICATION FOR BUILDING PERIVIIT INSTRUCTIONS Date .................. ,19 . a. Ttfis 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 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 necessa~,4inspections. ~- ~ f') - -" ('~"'~i};~u;e'of a' -'~li'can''' ~];r n"" ~n'el li ~ . . . . (IV~fiiling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................... Name of owner of premises ./'.'~/. ............ ~:j~gLqq.~. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpprate officer) Builder's License No. /LJ / ~ 5- ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which ~roposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... /.~ ........ Block ..... ~ .......... Lot... l .~ ............. .... ~ . . ~ ...... .....~ ,~t Filed Map No. Lot 2. State existing use and occupancy of~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ~7 .......................................................... b. Intended use and occupancy .' .......................................................... 3 ~'Nature~af~ ,Ice--tilth ap'plicable): New Building ..... ' .....'Addition ..... Alteration .......... 4. Lst~ma~~ ........ ~ ......................... Fee.. ~. ................................. ~ ~' (to be paid on filing this application) If dwelbng, number oB~welli~g ~mt ........ Number of dwelling units on each floor ................ If garage, number of ~ars*~: :'[..~ ........................................................... 6. If business, commercial or mixe0 occupancy, specify nature and extent of each type of use · ~o .~ ............. 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ........... d... Number of StoHes. .~ ................................................... D~enslons of same structure w~ alterations or additions: Front ~ i ......... Rear .................. Depth ~ Height Number of Stodes 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ' pth 9. Size of lot: Front .......... 4 ........... Rear ...................... De ...................... 10. Date of Purchase .......... ~ .................. Name of Fomer Owner ............................. 1-1. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....................... ~. ~ ..... 13. Will lot be regraded/~.~.... [ ..... ~ ............. Will excess fill be removed from premises: Y~ No 14. Nme of Owner of premises~~ ........ Address ................... Phone No ................ of Architect ... ~... ~. ~ ....... Address ...... ~.. ~ ........ Phone No P~T DIAG~M Locate cle~ly ~d dist~ctlg ~i bufid~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street and bloc~ number or description accord~g to deed, ~d show street nines and indicate whether inte~or or corner lot. STATE OF NEW YORK, COUNTY OF ................ d/ (Name of icJ~ividual si above named. S.S .! ..................... being duly sworn, deposes and says that he is the applicant ?lng contract) He is the ....... l .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this application; that all statements eon'rained/n this application are true to the best of his knowledge and belief; and that the work will be performed in the mander set forth in the application filed therewith. Sworn to before me this ~ #gffilt~0[ ........... .4Y. ......... day f .... ....... ,19t. . Notary Public, .... ~..~. ~ .t. ff.~. ..... County ',~JF':~,,v,~" ~ ..... : ................ i ~' ~ (Signature of applicant) P P-.O P a' P-.Ty AT' 'MATTITUCK