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Home My WebLink About14760-z FOII~[ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEPdvIIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14760 Z Permission is hereby granted to: c-~.~..,o~.~d-......~..:..q.,...l.,~%'?..l ........ , ~ to...~c~... ~-~-o ~~~ ~ ~t v~i~ ~oted .t ...~.k~.....~ ........ ~ ......... co~w ,~ M~ ~o. ~o0o sec,~o. .... l..~.3 ....... ~,~ ...... ~..1 ........ ~o, No ..... U. ............... Building Inspector. and approved by the Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examined..~../..~..., 19 .~..(P Approved ............ ~. ~ 19 .~.~. Permit No. .} '~- 7- '(&0' · '~' Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,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 b, !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. ?.,:, .*¥. ......... (SignatuFe'6f applicant, or naxf~, if a corporation) [5.*. 5.',5.,5., L.o 1 J0 .g."}-1 · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~-~ ,,~ cs,,. .... .Q~.o.~..x:. r. cx.o.'r.o.~ ............... ". ...... v ........................................ Name of owner of premises · .~. .¢. ~ .......................................... (as on the tax roll or llttest 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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed ,work will be done ................................................... .... Hamlet House Number Street County Tax Map No. 1000 Section ....... [~. 7 ....... Block ...... t ............ Lot .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b..Intended use and occupancy ..C.!9.~_. ~' ~r'..¢a.~J.e¢..o. .~o. cr[x.~.[¥¢,' o.W. n.c~... R~p~d~ ...... ~. · · '..k,~ · ~val .............. Demolition .............. Other Work..}T.O.~lac~g.~. .... '!ii ~0 ~ [l~ (Description) 4. Eslm~ted Cost ..... { .9.~ ~¢ ......................... Fee .... .~.~: ~.~ ....................... ~ ~'~ "' ..... ."7;~ ~' ~' (to be paid on filing this application) i&w * 5. elling, number of dwellin units ............... Number of dwelling units on each floor ................ If g~age number of cars ' 6. If business, commercial or mixbd occupancy, specify nature ~d extent of each type of use ...................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure With alterations or additions: Front ................. Rear .................. Dep~ ...................... HeiSt ...................... Number of Stories ...................... ' ' Front Rear Depth ' 8 Dimensions of entire new constmctton: ~ght .... Number of 9. Size 0flor: Front .......... ~ ............ Rear ...................... Depth 10. Date of Purchase .......... ................... Name of Fomer Owner ............................. I 1. Zone or use district ~n which p~em~ses ~e situated ..................................................... 12. Does propo~d construction vi~late any zoning law, ordinance or regulation: .~.~ ........................... 13. W~I lot be regraded ....... J... ................. Will excess fill he removed from premises: Yes _ No 14. Nme of Owner of premises ..... ~ ~. Address3a~o ' ' ' ............. og~[g .......... Nm~ of Architect ......... . ~ ................. Address ................ ~hone No ................ Nme of ContractorB,~.~ r.,r'~.~**~ S~.~. AddressEO *~.~5.~ ff ...... Phone No. D6.5'raq 5.0 .... - PLOT DIAG~ Locate cle~ly ~d dis~ct~ ~1 bulldogs, whether existing or proposed, ~d. indicate M1 set-back d~ensions from prop~~e~~ock number or desc~ption accord~g to deed, ~d show street nines and indicate whether STATE OF NEW YORK, ~S.S COUNTY OF " ............................ r ..................... 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.) of said owner or owners, and is du. ly authorized to perform or have performed the said work and to make and file this application; that all statements conltained 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 .... t/.d. ....... day ............ , Not~ ;3~11:, .~ ................ County KO~ARY PUBt~ ~ of Hew York ................. ! . I .80._47078711, ~lk boat~- '7 (Signature of applicant) ] lerm I:xplre~ Mirth $0,