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Home My WebLink About14689-z FO~ NO. ~ TOWN 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) 14689 Z Permission is hereby granted to: ...... ~..~..~.~.....~..~....~......~ ...................... ...~.~.~....~.:..~.,:......!.!..~..~..~ .............. ,o ........................ at prem~,e~ ,~oted at ...~..~..~....,~,~......~..~....~.~ ........ ~~ .............................. County Tax Map No. 1000 Section ....0....~....~.. ...... Block .... ..C~....~. ........ Lot No ......... ..~..,..J. ....... pursuant to application dated ...... ].x~..~.C~l....~. ..................... , I9.~..~.., and approved by the Building Inspector. Fee $...'~..: ................ Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined..'~...0~.....~,1..., 19.~.~. Approved . . .~.C~..~ . .~.).., 19 ~ .~. Permit No. ) .~..[?.~.c) 3.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece±ved ........... ~19... Date .................. , 19... INSTRUCTIONS a. This application must be completely filled hi 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, bui/dir~gm~de, housing cg~le,~and regulations, and to admit authorized inspectors on premises and in building for necessary (Signa~ur~'~an~,~a~n'e] ifa corporation) (Mailing address of appliqant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises -- ~. (as on the/fax 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 .... 4.4.c/0.e.. ....................... ................. "~'0' O)"' ~'~?'~' P ' '/'~/r;~i '//'q'2/''/ ~'~ Hamlet Itouse Number County Tax Map No. 1000 Section __B~lock . . .~. .............. Lot. '. Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use an//occupancy of premises and intended use and occupancy of proposed construction: 71 a, Existing use and occupancy . . .g~. -- ."T. .................................... b. Intended use and occu_pancy. ,(~.. ~., . ~. ]q/~ .P~.. 7T.../~,//J~ff..~..[ ~/.t~., ~.. ................... i ' teration, 3. Nature of work (check which appl cable): ,New Building ........ Addition... ~ ...... A1 ,.. '...,... 'Repair .............. .~ --Rem°val .............. Demolition .. ..... ~ ....i. Other W°rk'/¢'~--'i--'(D&~criPt on) ''' 4. Estimated COS ........ Fee ........ i .......................... (to be p~id on' filin~ this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units Ion each floor ............... If garage number of cars 6 Ifb si mercilormi do cup ncy sp cffynat and extent ofe htyp iofuse · u ness, corn a xe c a e ute ac e .................... 7. Dimensions of existmg structures, if any Front ............... Rear ........ ! ...... Depth .............. Height ............... Number of Stories .............................. : ......................... It dditi i Rear ........ Dimensions of same structure with a erations or a OhS: Front ............. , ............. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear .... .~ ....i ......Depth ............... Height ................. Number of Stories ................ { ............ ! ........................... Size of lot: Front . .]..~./~(t~,4~-....~.t... Rear .~. ~qv. ........... Depth ...................... Date of Purchase Name of Former Owner Zone or use district in which premises are situated .......................... , ........................... Does proposed construction violate any zoning law ordinance or regulation: ,' Will lot be regraded ,,, ~9 ..... ,~ ................ Will excess fill be removed from premises: Yes Name of Owner of premises .'~J.~.oY//f~. C.~./r..~..~... Address ~J~.q(? .~.# .//.d.~fl... Phone No. ~.~...2~'/J~.'.... Name of Architect ............... Y. ....... '... Address .'. .................. Phone No ................ Nane 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 showistreet names and indicate whether interior or corner lot. 10. II. ~2. STATE OF NE~Q~K,, ~ ~ o ::,,'; ,., ".,,, ,~ ~z ~ Pt UMBING ' · · .~r~'~l · .~:~ ~ ....................... being duly sworn flepB~es aha saE~ tha~,B~4~,the applicant (~n~viaua~signing contract) : above named· ,' '~ ~,'j ~ :~,.;,,::. ~Cr~O~ · ENERGY Heisthe ..~ ................................ ; ~c-,; ~, EFOR ............... , (Contractor, agent, corporate officer, ~)~[BIq of said owner or owne~, ~d is duly authored to perform or have perfo~ed the s~id work and to m~e and ~e this application;that all statements contained ~ this application are true to the best of hisi~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this , //(Signature of ~p~licant)