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Home My WebLink About14753-zTOWN 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) grcueted to: . , Permission is hereby t...~ ............ ..~. J~..o~....~b .................... ................ of premises ,ocoted ot ..L..~....~......~~....~...°~.....~...l~..~. ....... ....~...~ ....... County Tax Map No. 1000 Section ...... ,~..~.....'~ ..... Block ..... ~.,..~... ......Lot No ..... I.~ ................ oursuant to application dated ....... ..'.'.~ ........................... ~ 19.~...~., ond opproYed by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine ''/ ., 19~.~°. Permit No./..~?.~.~...~... Approved~...~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF $OUTI,'I, OLD I~ece±ved ........... ,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 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 necessary inspections, d~) [//~ t ~' ~ ...... .... (Signature of applican(~ ~ 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 ..... .~. }~J~. ~...~.}....~.f.~.J~..~.~...~.'.F.~..~ .Q{~..,~.. ........................ (as onthe tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No..~. :~.....~...r~..'-p~.) .... Plumber s License No ......................... Electrician's License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be done .... [ ~...~.~..t~h ~..~o...~.~.. {?}~\~.~ ............. cou t Tax 1000 Sectio. .... %.Q ........... Block ..... .9_.. .......... Lot..!! ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....~, j~.[: .~...~..~...i.~..01 . .~.~...~"'/I~. ........................................ b. Intended use and occupancy.. :~.'... J [\.~{'..~ ..... ¢[.~ .~.~.t...~..¢.~..~.~..~.....~. O~.~.4~c~..~.o.~....~. 10. 11. 12. 13. 14. 3, Nature of work (check which applicable): New Building · Addition.. . Alteration Repair .............. Removal .............. Demolition ' Other Work ...... (Description) 4 Estimated Cost ' (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 ' 6. If business, commercial or mixed occupancy, specify nature and extent of each tybe of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............... Height Number of Stories , Dimensions of same' structure with alterations or additions: Front ' Rear Depth ................ U. .... Height ...................... Number o~ Stories ..... ~ . Depth Dimensions of entire n~w cogstruction: Front ............... Rear ........ ~ ..................... Helg t ........... Number of Stones ..................... S~ze of lot: Front ...... ~f~...~,' ....... ~-. Rear ..... .~.0 .............. i?:~th . Date of ~urchase ...... .~..T:.~'fl¢.l~t~.. ........ Name of Former Owner .j..7.~. 'ie-A-rt~ .~.~.~Z...~ 0 to/~/t/O~ i i .......... Zone or use district in which premises are situated ......................... , ...... Does proposed construction violate any zoning law, ordinance or regulation: .... i. · · fJ,,o ..................... Will lot be regraded ................. .~. .......... Will excess fill. be removed from premises:. Name of Owner of premises ./-~-~J-On~l.~.0~2dress/~t~3. R,~,l~,,[.~, (?jq/,.. Phone Name of Architect ................ ,/ .......... Address ..... i ....Phone No ............ .... Nome of Contractor .......................... Address ............ ' . Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all 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. : Ap~?~OV~r~ A~ NOTED NOTIFY ,~U,~LDIF~G DEPARTMENT AT 765-1802 ~ .A~ TD 4 PM FOR THE FOLLOWING ~SPECTIONS: FOR PO~ED CONCRETE 2 ROUGH i- RAMIN(~ & PLUMBING 3, INSULA[tOrl 4. FINAL CO~STRUCTION MUST BE COM~.~TE ~R C O, ALI CONS~UCTION ~HALL MEET THE REQUIREMENTS OF THE STATE CONS'r~RJC~ON ~ ENER~ STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract above named. He is the ........................................................... : ............................ (Contractor, agent, corporate officer, etc.j of said owner of 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 of hi~ 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 (Signature of applicant)