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HomeMy WebLinkAbout14643-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) 14643 Z Permission is herebf granted to: ................... ..~~..~......~.,.¥.,...../.r..~ ........ at premises located at .....~.. ......... ~~..~......~.~¢~..~j~.. ........................ County Tax Map No. 1000 Section ...... ..~....~..~ .... Block ...... .C)...I'~. ....... Lot No.....~...-~ ............. pursuant to application dated ...,~~~.....:~..] ........... , 19.~.(~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Examined..~0,~. ! .-%... Approved . .~..o:4~. ! .~r. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 ).¢ ., 19~P. Permit No. loct~ 9a'~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TOWN OF soLm{o __ Received ........... ,19.., Date .......... 19..· a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 hall 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 hail 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 '.uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to trait authorized inspec, tors on premises and in building for necessaw inspections. .. ~..~..~..-~ .~.4..~....-~.. ~ .~.. ............. (Signature of applicant, or name, if a corporation) · (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly autborized officer. (Name and title of corporate officer) Builder's License No ...... 07.~. ~.... ........... Plumber's License No..../.r~?..~./5.~... Electrician's License No ....................... Other Trade's License No. ~-- t ~ Location of land on which proposed work will be done· -/q x~ / ~ / 'D ~_~ t5 · ....... ............. ............ llouse Number Street Ha~nlet County Tax Map No. 1000 Section .... ~. ?.5 ........ Block ..... . .~.'. ......... Lot .... 2. Z .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended us~ud occupancy of proposed construction: a. Existing use and occupancy ....... : .-: .,-~....~?.z.4: : ........................................ b. Intended u~e and occupancy 3. Natu~re of work (check which applicable): New Building .../~ .... Addition .......... Alteration .......... Repair .............. Removal .......... Estimated Cost . . (e ~. ~..*..~..'..~..~? ....... If dwelling, number of dwelling units ...... Z' · · If garage, number of cars ........ (~..~... ~ · Demolition ........ ?.. Other Work ............... (Description) ......... Fee .......... : ............................ ~' (to be paid on filing this application) ... Number of dwelling unitis on 6ach floor ................ ~. If business, commercial or ,mixed occupancy, specify nature and extent of each type of use ..................... 1. Dimensions of existing strugtures, if any: Front ............... Rear ........ ' ....... Depth ............... Height ;Number of Stories Dimensions of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ............... , ...... Iteight ...................... Number oflStones ...................... ~. Dimensions of entire new ~onstruction: Front . . ~'t~..~7 .... Rear ..... ~..d4 .~.,.. Depth . .~,?.~...~. Height .............. i. Number of Stories .... .e?<~..,;%.~./>) .........:... i ............................ Zone or use district in w ch premises are situated. ~F~..~ e'~<, 772..~7 d'~ ./~<~ c~.; .b }fl. c7- - !. Does proposed construction violate any zoning law, ordinance or regulation: . .~ .... t. Will lot be regraded ... '. >('. t?,L,. ................. Will excess fill be removed from premises: Yes No Name of Architect Address ~ ... Phone No. Name of Contractor .': Address Phone No PLOT DIAGRAM Locate clearly and .distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from operty lines. Give street and block number or d~scription a~ccording t6 deed, and shoo street names and indicate whether terior or corner lot. 4 ~orn to before me this ; / .day of. ........ , ~N A. RO~ER8 NOTARY PUUIIC, State of Now YO~ No. 52.46H, OgL Suffolk Count~ ~erm ~piros March 30, 1~ (Signature of applicant) 'ATE OF NEW ~ORK, ,7//~c~.~ 5/ )UNTY OF..~.~.~.:~...... S.S ...~?~.Td~/'d/.~. %u. .~..~.e./?.o. 3. ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ore nanled. .~' is the ......................................................................................... (Contractor, agent, corporate officer, etc.! ' said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this .plication; that all statements contained in this application are true to the best ofhi~ knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith.