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Home My WebLink About14350-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 14350 Z Permission is hereby granted to: ..... . .(/Z.~.~z2~.,~...~....:~..-..~ .,4 ............ ...... ~...~7.....~. .......... ~ ............. Z~..: ......... ...... ~..~...~.~,...~. ~ ....~.z.c:~..,(~. ro ....~cl.,~..~.. z~.~.c.:ZZ........,~..~<¢.~. ........................................................................................ at premises located at County Tax Map No. 1000 Section ..C~)...~..~.. ........ Block ...~..~.. ........Lot No...~../....~.. ........ pursuant to application dated ..................... ~.. .............................. , 19 and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 Approved .~. ~... · · ;..~.'. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 TOWN OF SOUTHOLD Disapproved a/c ....... -=..."..-:~:. · ..... '.-'~. ..... ~ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date t/~/~, 19 ~ 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 gi¥ing 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 necessary inspecgons. ~ ~ admit authorized inspectors on premises and in building for ...... ~. C. ': ~'i 'n' .... (Signature of applicant, or name, if a cor~orat'o ) .... :,/. .. i.o.o. ?. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............................. , .......................... (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. ~!~...t~..~?..~?. Plumber's License No..~...~..~ ! .&q?..¢~..~. .......... Electrician's License No. ~Tg~4~; 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section . .4'.~. ............. Block ....~ .............. Lot. ~ ............... Subdivision.~..l~..~?..U~..g..~..~. ............. Filed Map No..~.&'~ .......... Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~~ ......................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..~...' ..... Addition .! ......... Alte~ ..... Repair .............. Removal .............. Demolition ........... i ....Other Work 4. Est~ated Cost ........ t~ ............................ Fe~ ..... ~.i ............. *' (to b~ paid on filing this application) ' 5. If dwelling, number of dwe~ing units ...I . ....... Number of dwelling u~its on each floor .......... ...... If garage, number of cars Nb~g ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear ..... ~ ........ Depth ............... Height ............... Number of Stories .......................... ~ ............................. D~ansions of same structure wi~ alterations or additions: Front .......... ~ ...... Rear .................. Depth HeiSt Number 0f Stories . ' ' 8. D~ensions of ent?e new construction: Front ~~O~' ' ....... Rear ~.'~Q'~ ........ Depth ......... 9. Size of lot: Front ..................... l/ear.. 7~.~ ............... ~ pt ' . ....... 10. Date of Purchase . (~~ .............. Name of Fo~er Owner ! ~ 11. Zone or use district in which premises are situated .................. 2 ............................. 12. Does proposed construction violate any zoning law, ordinance or re~lation: 13. Will lot be regraded ... ?~. :.. .... ~..2., ~, ..,.. .... Will excess fill be remo¢ed from premises: Yes ~No 14. Nme of Owner of premises .~i~,~'.~J... Address ~i~ Phone No. Nme of Contractor' Oi ' ido) b ,b bbb ' " i is' a ...... k' ...................................... ~ ..... o eNo.~ ............. PLOT DIAG~M Locate cle~ly ~d disthctly ~1 bufldhgs, whe~er existing or proposed, and, ~ndicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or description accordhg to deed, ~d sh:ow street nines and indicate whether integer or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~He is the ........................................................................................ (Contractor, agent, corporate officer, et~.) of said owner or owners, and is duly authorized to perform or have performed tM said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................... · ~....day or Notary Public, ~.~:..(~~... County//~-~ , · .., Not,r, __.,,... Vet, .... Ot~allflod In Bronx Coun{4~ Commission Ex[~lros ~ arch 30, .9~-/ /