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Home My WebLink About14788-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14788 Z Permission is herebt granted to: .............. ..... ...'Z'.~..~.~ ....... L...q...~...~ .................................. tO ................. J~ ............ "~'~ .................. ; ....... '; ....................... 7 ..................... ~ ................. ; ........... ': ............ at premises located at ....~....o~........~....~~...~-....~..~.....~...,. ...... ~..~.C~ ......... CounW Tax Map No. lO00 Section ...... !...~...~. ....... Block ...... ,,(~,...'~.. ...... Lot No ..... '~.~. ............ pursuant to clppJication dated ..~.~~...~ ................... , 10.~...~.., and approved by the Building Inspector. Fee $..~ .............. Building Inspector Rev. 6/30/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO LD, N .Y. NOTICE OF DISAPPROVAL ./..~//.,./.c~.c~. ~..:~ .... ./.<7. d'd. PLEASE TAKE NOTICE that your application dated .....~..~./~.4~..fi)...~..~.... ?..., 19 .~... for permit to .........'o ' .... .... ...... ..... .... ..............,.......... .... at Location of Property : "~" ( .... '~'t/e$i ........... i~"~' /' "~"C ~C'--~/' ~'''""'I-l~mlot County Tax Map No. 1000 Section . / ~.~. ....... Block . .O..~ ........ Ix~t . ~.~ ....... Subdivision ' Filed Map No.. ~ Lot No. ~ is returned herewith and disapproved on the following grounds ............................... ... ~.o~ ~. , .~. . . ~ . .~. . ~ ........ < ..................... W Building Inspector RV 1/80 i · 'FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT · ~ TOWN HALL 8OUTHOLD, N.Y. 11971 \ ':' TEL,: 765-1802 Disapproved a/c ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT.'~ j ?OWN OF SOUTHOLD,, ~ Received ........... ,19... Date. ~- 7 19 I INSTRUCTIONS a. This appii'C~'tion 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 .a.~c.~grd~ng to schedhle. b. Plot plan showing location of lot'ah~foUbuil~ting~ on premises, relationship to adjoining premises or public streets or aYeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli, c. iThe 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 Occupanc shall have been granted by the Building Inspector. ' APP ICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicab, l% ~ws, Ordinance~:o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolitioia, 'a'~ herein deseriCed The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t¢ admit authorized inspectors on premises and in building for necessary inspectiolis. ~ , ' / (S~ture of applicant, or name, if a corporaiion) · · ~X ~ ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, ar6hi{eOt}, 6ngineer general contractor, electrician, plumber or builder. Name ofownerofpremises . L~ t5 ~ .~,, ;; , ,' : . ' ~ (as on the tax roll or latest deed); If applicant ig a corporation, signature of duly authorized officer. '~: ~, (Name and title of cmporate' officer) Builder's License No er's L.i e N ~ ilectrician's License No: ': .........., ....... ' Other Trade s License No, ........... ~ ', ..;' ' · . Locatmn of land on wMch proposed work wall HouseNunpe~l~ ",~,-' , ", ',',.','; Street .x,,, ,, ,' Hamlet ~ou~y 'T~ Map' No~t1000 Section 47.~ t ~ ~.' ,.~. ~. ~.~¢:, J Block ~.... ,. i.: .,: 2:'.. [ ,';..'; Lot .' ........ ' ..... ,.. ,.. ~u~dVls01 :~'. ..... '.,'i;il; ......... ;;',.;;; ...... '; FlledMapNo ~ ' . ,; .... Lot ............... ~-, '~ '" ' ' ~ (Name) . S~ate ex~stmg use and occupancy of premises and ~ntended t se and occupancy of proposed construction ,,~: l.,~end~d ~so a~d occupancy ~ , ,',: . ' ~ . , , . : . .. ,' L':?~:,, ,~!'t~ ',,. ~ ,e, ~ ,,', , ' ' ~ Alteration , Nature of work (check which applicable): New Building .......... Addition ........... Repair Removal Demolition Other Work i ~,', (Description) Estimated Cost ........ : ............... Fee ........... : ......................... * (to be p~id on filing this application) If dwelling, number of dwelling units .............. Number of dwelling units [on each floor ............... Ifgarage,, number of cars . ........................... . ~' .......................... If business, commercial or m~xed occupancy, specify natur~ and exteut of each type of usc ~Etff.~. ~~. .r. ~ .~. ~.,.~..~_ Dimensions of existing strUctures, if any: Front ..... .ff.o. ....... Rear ...~..~. 7. i ...... Depth .. ! P..~..t ....... Height ... 2l ~.. ! ....... Number of Stories .......... .~.~ ~'. ............ i ........................... Dimensions of same structure with hlterations or additions: Front ... ,CO.' ...... , ....Rear .... "/..~..' ......... Depth ..... /. ~. ~...~ ........... Height ...... /ff..t ............ Number of Stories .................... Dimensions of entire new construction: Front ..... :g-. ~'.! .....Rear ... 2. ~'. i. . .. . Depth ...9. ~. ! ... . ' Height .... I.~.t ....... Number of Stories ..... ~..O~IE, .............. ~ ........................ Date of Purchase ..i .... t~.~ ..'777..../. ~.~\~..~q.~I~o~ra~Owner .. i..~c~ ~ ~.... Z~ ~.~.r... Zone or use district in which premises~a..~ ~a ..... } ........ ~.~.. m~.~ .... Will lot be regrafled ...... ~.5~ o..~X~et~cess fill be removed ~nom premises: Ye~/~ No Name of Owner of premises ~.~k~..~hs[t~P~ ~.4 ~. e.~ .tl,f?. Vhon~ No.$.q 7:.. Name of Architect ......... -.~. k~... ~X~.~ ............... !... Phone No ................ Name of Contractor ......... ~. ~... ,~ ......... . ....... ?.. Phone No ................ Locate dearly and distinctly fll build~, wh~th~r existing or proposed, and, tndkate all set-back dimensions from ,perry lines. Give street and block number or description according to deed, and show Istreet names and indicate whether erlor or corner lot. TE OF NEW YORK, S.S INTY OF ................. ~ ~' ~t' ~L~ ~ being duly sworn depos~es and says that heis the applicant (Name of individual signing contract) ,e named. (Contractor, agent, corporate olfi.cer, etc.) aid owner or owne~, ~d is duly authorized to perform or have perfonned the said work and to make and file this ication; that ~l statement~ contained ~ tiffs application are true to the best of his knowledge and belief; and that the 3~ will be perfo~ed in the m~ner set forth in the application filed therewith. m to before me this ~~ '~:~ ...... ~ ~'",' ' (S]gnat~;e of applic~t)