The URL can be used to link to this page

Home My WebLink About14650-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) 14650 Z Permission is hereb/gront~Lto:, C~.....~..b,~.......~..~ ............ ..~~.~...,....~.:.~.,. ...... ~./.~.~.~ ........ , ...... = ...... ............. o, ~,~i~e~ ,~,~ ~, ...~..~.~ ...... ~..~....g.~ ............ G~~ ................. .../~....~.,....~.~ ...... ~.!~.~....~~....~ .................................................. co~.. r~x Mo~ No. ~000 S~,io~ ..... ~.~.~. ..... B~k ...... ~..~. ...... Lot ~o ....... ~..~ ........ ~uildlng Inspector. Rev. 6/30/80 ,. , ~ -, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 , TEL.: 765-1803 Examined.. ~.q,~V.C~. ! .~..., 19 .~ k Approved. )f~..O4...~../.ff.., 19 fl.~. Permit No.! q.~..~..~...~.. Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. OE~ T TOWN OF $OUT,~'~O~ f3 Received ........... ,19... Date ................... 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 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 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 inspe~ns.// // ~ ...... 11. 4.c:.,57. .~. .v. . . .~<>~z. ~. . .-/-. ?.,,~. . ~ (Signature of applicant, or name, if a corporation) ...... f :/. ~ ........... ~. ~. .~. . .~z.,. . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~..~. £~/~-~.-.-,: .................................................. Name o~-owner of premises. ~..~-../.~..~ .¥~,. ~..d.. ~.~../. ~ .~. &.,~/..~.x....J../?. d .......... (as on the tax roll or latest deed) If applic011t is a corp~atioo, signat~re of, dtkly authorized officer. ... ......... (Nmne and title of corporate officer) Builder's License No .... ~.' ././ ................. Plmnber's License No. / Electrician's License No ....................... Other Trade's License No...'~..: ................ CS~d ,~ ~ ~"7',',7 ~ ~ Location of land on which proposed workz~.X. "'--will be done ............................................ '~' '~' ' 2 ~"'- ~ .~./. 'C'.~ '/. '.~./ ............................... .z.~ ...................... ~.~.~ ........ llouse Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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.....~..o./..~..~..c~..rTL'.. )[.~.~ ........................................... b. Intended use and occupancy ..... w~.t.. [ .......................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... A~dd~..; ....... Alteration : Repair .............. Removal .............. Demolition ....,re ..... ;.. Other Work ............... (Description) 4. Estimated Cost ..... ~. ....................... Fee ..... i ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of cars ............................................ ! ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... ! ....... Depth ............... Height ............... Number of Stories ............................ ! ............................ Dimensions of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ...................... Height ...................... Number of'Stories ...................... ~ 8. Dimensions of entire new construction: Front ............... Rear ........ ! ....... Depth ............... Height ............... Number of Stories ............................ i ............................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. I I. Zone or use district in which premises are situated ......................... ~ ........................... 12. Does proposed construction violate any zoning law, ordinance or regulatinn: .... i ............................ 13. Will lot be regraded ............................ Will excess fill be removed from promises: Yes No 14. Name of Owner of premises .................... Address ............... (... Phone No ................ Name of Architect ........................... Address ............... i... 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED D~TE: t B.P ~ -- '- .. FEE: J-5-&-;---~ ' ---- ' NOTIFY BU!LDING DEPARTMENT AT 765-1802 9 FeLt,OWiNG INSPECTIONS: STATE OF NEW YORK, 1 FOUNDA~rlON ~0 REQUIRED COU~Y OF ................. S.S FOR POURED . . , 2 ROU~ ~FRAMiNG · pLUMBING ................................................. oeing amy ~q~E~and says t~ t * c a ' plicant (Name of individual signing contract) Z FINAL ~20~SI,UCI't~%~ above named. B~ CO~PLe:'F~ Ac[ CONStaUCX)ON He is the .................................... , ~H~ ~UiBEMENT8 Of THE N,V of said (Contractor, aglnt} ~3J;a~J'~'~[~'~fl$'rMuc*(~~[~N~[~~ ~ tNfi~OY ........ ow.o owno , ,o o.o m avo pp ~catmn; that ail statements contained m th~s apphcatmn are true to the best ofh)s ~owledge and belief; and that the work wUl be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ........... ~ ........... day of ...... ~ ..... , 19 ~4 Notaw Public .... ....... ~g~ ~'~ :,', (Signature of applicant) Term Exnir~s Ma~ch 30, 19~