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Home My WebLink About14356-z FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 14356 Z County Tax Map No. 1000 Section ....~(~...~.....~ ....... Block ...... .C~...~ ........ Lot No ...... .~.L ........... pursuant to application dated ..... .~.~....J...~. ................. , 19.~..~...-~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 rmBUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .O~..t.~.~..., 19 .~ .~". Permit NoJ.~..~..~. · .~... Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. OEP'L TOWN OF SOUT_FIO~LD,~.,~ Receivedt x~z'PP- ......... 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 ~ 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, bu: !ing code, housing c~, ajld.z~ulations, and to admit authorized inspectors on premises and in building for necessary ~.~ ~tions. _~'(r'~ ~'[ ~0 (~ ~re of applicant, or name, if a corporation) r ih'ailing address of applicant)'~*~ ~ ~ - State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Otkcr Trade's License N~ ...................... - (as on the tax roll or lat?~st/de, e.d) - ~.e! If applicant is a corporation, signature of duly authorized officer. D ~T~ / 76: ig~ c, [:~, ~;~t: A .'~;~ , ,~:~ ',~ ~ O~L.O~r~, a~.~ .... '7. 3. INSUI..A ~'~ON 1. Location of land on which proposed work will be done ............. ~TgT~ 'CC~$'1 [~J¢~?lb'h] .. .............. ... ...... ......... :,, ...... ..' · U'. - House Num bet Street Hamlet County Tax Map No. 1000 Section . .~.0. ~.q.. Block ........ I ' Lot ..... Subdivision ..................................... 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 ....... [ .... ~ ~.~t. ~.~. ~¢( ~ ~ b. Intended use and occupancy ...... ~ ....~.~. · · - .~.~.~.{.~.g.. · ~1~... ~.~ ....... 9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition ~ ........ Alteration .......... Repair .............. Removal .............. Demolition ......... i .... Other Work. ~'.gM~'... ~'~ ~k ~ (D ese ription) Et~ dC ' s ate est ......... Fee .... ! ..................... (to ~e paid on filing this application) If dwelling, number of dwelling units .............. Number of dwelling ufiits on each floor ............ If garage, number of cars .......................................... ~ ............................. If business, commercial or mixed occupgney, specify nature and extent of each type ofuse ..... ...........' ' ' ' .... ..... . D~enslons of existing structures, ~f any. Front ........... Rear ......... Depth .......... Height . . ~.~ ......... Number of Stories ..... ~ ................. ~ ............................. D~ensions of same structure with alterations or additions: Front .......... ~ ....... Rear .................. Depth ...................... HeiSt ...................... Number bf Stories ...................... D~ensions of entire new construction: Front ............... Rear ...... ~ ......... Depth ............... Height .............. Number af Sto~es Size of lot: Front ...................... Rear ..................... :. Depth ...................... Date of Purchase ff~ ~ Name of Former Owner[ Zone or use district in which premises are situated ....................... 1 .............................. Does proposed construction violate any zoning law, ordinance or re~lation: .. ~.~ .......................... Will lot be regraded ............................ Will excess fill be removed from premises: Yes No Nme of Owner of premises .................... Address ............. ~ ......Phone No ................ Nme of Architect ........................... Address .................... Phone No ................ Nme of Contractor .......................... Address ............. ...... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,iind~cate all set-back dimensions from property lines. Give street and block number or description according to deed, and sllow street names and indicate whether interior or corner lot. O STATE OF NEW,,YORK, COUNTY OF ~ ..... S.S .... ........... (Name of individual signing contract) above named. ..... being duly sworn, d6poses and says that he is the applicant He is the ........... 0 .tO. Mt~ ................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed th~ said work and to make and file this application; that all statements contained in this application are true to the best oflhis knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith, i Sworn to before me this : .... ........... ...... , : Notary Public ................ ~.. County, (~ ' i i:!'[~~ ,~ f~..~ , "i/? ...... ~ i ,~(~,.i~',l,,li~!- ~ I~ i