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Home My WebLink About14645-z I~ORM NO. ~ TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1464 Z County Tax Map No. I000 Section ..... .~.~....0. ........ Block. ....... L...~.. ....... Lot No ..... .~.~g..'..~ ....... BuildlngpUrsuant Inspector.t° application dated .......... ~..~ ...~.~ .............. , 19.~1...(R., and approved by the Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL EOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~t/~0t&f~.l.~. ·., 19 ?~'~.i," : ' Approved..~0~&. !.,~: ,,4'9 .... Pem, t No ..... - ...... Disapprovea a/c ..... ~ · ' ',' ¢~' ;¥5'' ' · ..: ~:' ' '~ .... ~* ........ , ~. ~ ~ ~3 ~,,~ (Bmldmg Inspector) "~' ~' APPLiCATIO~ FOR B~I~DI~G PERMIT TOW~-b~ 'SOUTHOLD Rece£ved ........... ~19.. · INSTRUCTIONS a. Tlfis 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 Buildfng 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 ~ 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. .% ............ (Signatu~re~of applicant, or'flame, if a corporation) a--.. lq.¥. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ..Ce.*.?~..~..~.l...~..,~-r r.~..~.w .o.c. ..................................................................... ................................. Name of owner of premises ..... .--...~,e.,.~,~ ?.. p.~ . (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 ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ....~..C? .......... Block ... J. c:~ .......... Lot .... ;~.~... I ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3, Nature of work icheck which applicable): New Building ..... ' .....'Addition .......... Alteration . .~;~..-.~. Repair ... Removal .............. Demolition .............. Other Work ............... ~ (Description ) 4. Estimated Cost..'~ ] ~ ~-> ~ ................................. Fee ......... ~. ...................... '~ r i (to be paid. pn~ filing this application) :5. If dwelling, number of dwellin~ Units ............... Number nits on ea6h floor ................ If garage, number of cars .... ; ..................... ~~p~} ;.. 6. If business, commercial or mix6d occupancy, specify nature aq~-o~ea~f u ....... 7. D~ensions of existing stmctuies, if any: Front ..........~.~----~~'Z~a~'~ --__-- ----I:~.- -- ~ Depth .............. Number of Sto~es ............. ~ ..................... ~ith 1 D~ensions of same structure a terations or addition n .................. "8. D~ensions of entire new consimction: Front 10. Dati of Purchase ............................. Name of .............. 11. Zon~ or use district in which premises are situated ........ ' ....................................... ,1~ Does P~oposed construction vi~late any zoning law, ordinance or re~lation: .. ~. ~ ................... ,"...... ' 1~.~ W~I lot be r~raded ........ ................... Will excess fill,~e remowfffrom premises: Yes No 14. Nme of Owner of premises . ~.1. ~.~ ......... Address G¢.e.r~ro~.~... Phone No ................ PLOT DIAG~M Locate cle~ly ~d dist~cfly ~1 bufid~gs, whe~er exist~g or proposed, ~d, indicate all set-back d~ensions from prope~ ~nes. Give street ~d blocl: number or description accord~g to deed, ~d show street names and indicate whether ~terior or comer lot. Term (Signature of applicant) ~:EE. ~_.~.~.:_ ...... BY. ,. · - NOTIFY ~9~LO!N6 DEPARTMENT AT STA~ OF NEW YORK, 765-1802 9 .~ TO 4 PM ~R THE COUNTY OF ........... S.S FOLLOWING )~P~CTIONS: FOUNDAT[O~ ~O R~Q~IRED ' 1 'FOR'P~ d~N~ deposes ~d says that he is thc applicant (Name of [~d~vJduai signing co~tmct) 2. ROUGH FRAI~ING · pLUMBING above named, i 3. INSULATIO~i ! 4, FINAl. CO[~iSTRUCTtON MUST He is the ~ BE CQMRL~[ ~OB C O (Con i ~R~ 'S OF ~EN~QuIBEI~ENT OF~ ' aid ,o and fl, application; that all statements co~tained ~ this app~~~E~~ ~owledge and belief and that the work w~l be perfo~ed in the m~per set forth ~n the ~i~ff~~ ..,RRORS Sworn to before me this Nota~Public, ...~..~~... Coun ' ....