The URL can be used to link to this page

Home My WebLink About14797-z FORM NO. $ TOWN OP $OUTltOLD 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? 14797 Z Permission is hereb/gront~ed to: , .....~...o....x.....q...~. ........ 2 ....... Y .............................. ~, t~ ~ ' . ............................... at premises located at .....~.....~..../.?........~...~..~'...~.,..-.~........~...~-....~., .:....~.' .~ County Tax Mop No. 1000 Section ...... ~.....'~...'~ ....... Block ....... ..Q~.....~Z.. ...... Lot No.....O......~:~-,'F~ ...... pursuant to application dated ...... l....~. ...................... , 19..~....~., and Building Inspector. approved by the Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL *oOUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Approve~..~..~. ., 19~o. Permit No.l.~.')..t~ .~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... Date .................. , 19 .. a. Tins 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 tins 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 occhpied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildiflg 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 herain described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c6de, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applica , 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 ../~.~. ~ .tX .~.':...-.~-.~..:~...O ............................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ~..~.-~z~O.~.t.'G'. ~r~.~:.),-.. ~.~ .... · . . Hous~ Number Street Hamlet County Tax Map No. 1000 Section .... ~.'~..~. ......... Block .... .O..~Z. ......... Lot .... O. 2. 7~ ......... 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 ........ ~--ff~.~t/.E~.~/~.. ~ ............................................. .... . b. Intended use and occupancy .~.~. ~ L.-& ~... ~. 4-~,~. ~: :~'. · ~ .... ~..-~.,?,.~-~?. ~.>, ,.'- ............. 3. Na[uf~ ~f4*orl/(check which applicable). New Building .... 'Addition .......... Alteration ........ Rbpalr .............. Removal ....... i ...... Demolition .............. Other Work...-.~.~. ~ f~.~.. ~8 ~ ~ I (Description) 4. Est/mated Cost .......... ~/~.,4..~..,a,~ i ............ Fee ...................................... '~' (to be paid on filing this application) $. If dw ng, number of dwellin units .' Number of dwelling units on each floor If garage, number of cars ... ~~ ...... ~,~...cs ~..~.a~ ............................................... 6. . . , · ' - If bus,ness, commercial or mixed occupancy, specify nature~nd extent of each type.of use .............. 7. Dunenslons. of existing~ structures,, ff any: Front. ..... & ~r. ...... Rear .... ~. ........ Depth ' i ~' 5>' ' ' Height ...... ~ .......... ~O ..... Nu. mber of Stones ........ t ................................ Dimensions of same structure with alterationslor additions: Front ................. Rear ................. Depth ' · ...... : i Height Number of Stories Dimensions of entire new con~truction: Front. .............. Rear ............... Depth ............... 9. Size of lot: Front !~,-~..'... '' ' ........................... '~' ~/ ..... , agar ..... ~.~/. '. ............ Depth . ii l~. 10. Date of Purchase .. ;~-K~ ~.4'~,.¥ · · ~ .~.~.~ ....... Name of Former Owner .ff/,I .~. I~./~Cd.., .~ ~..~.~./~... 11.. Zorie or use district ' ' ~ ' ' in which premises are situated .................................................. 12. Does proposed construction viplate any zoning law, ordinance or regulation: ... ~.o .............. : ........... 13. Will lot be regraded ...... /~', O. .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ./~'f~.~-t .~ ~ .-T..~ ~. ~.. Address .~,o. ~,~.X .~:l. ........ Phone No. g.~ t..~ ~.*]. ~.~.. ~. ? Name of Architect ........ i ......~ ....... Address . d~.~:~ ~ (.2~.ff.~. . Phone No. ~'t Name of Contractor ..... I ..... ~ ........ Address . .. I~.,.~',..O.'~ .~..~.~(. 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 bloc: number or description according to deed, and show street names and indicate whether interior or corner lot. ,~ gtt / / STATE OF NEW YORK, ; S.S COUNTY OF ................. 1 .... (Name of individual signing contract) above named. e AS NOTED ~OTIFY ~UILU~G ~PARTM~NT AT 765-18~ ~ ~ ~O ~ P~ ~OR THE FOLLOW~N(~ ~NS~FECTIONS: I FOur'DA rto~ '~'Wf) ~QUIRED FOR POUf~O 2 ROUGH ~f<AMi~G & pLUmBING 3, 4, FINAL CO~!~TRUCT~ON ~UST DE CO[~PLE~'E ~OR C.O ALL CONSTROCTION SHALL MEET THE REQU1F[EMENTS OF rile N.Y ~ATE CONSTRUCTION ~ being duly sworn, d~~~~~. mESIGN OR ' (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements cohtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manger set forth in the application filed therewith. Sworn to before me this Notary Public ..... ~.. ~. ~. ~ v.~..~ .... County ] 7 '~ y (Sigfiatum of apphcant)