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Home My WebLink About14361-z ~l~.~ NO. J 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) N~- 14361 Z Permission is hereby granted to: .... ~..~......~¢: .............................................. ~_~.~ ........... .y......J.L~...../. ....... ~-, at premises located at .....~....~.~......~...~.~.,...~....~...?..t..'.~ ........ ..?..~.. ...... .~..~~ County Tax Map No. 1000 Section .... ,,~,..~.~...~ ........ Block ..... ..~,..,~,. ........ Lot No ..... i..~...,~. ........... 19..~..~..~, and approved by the pursuant to application dated Building Inspector. Fee $..?~....: ............... Rev. 6/30/80 Examined .~,>.~. I..~..., 19'~.< 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .1~.~. ).~..., 19~...~. Permit No. [ .q..~.~.[..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ToWN OF 'SOUTi~IOL Received ........... ,19.. · Date ................... 19... INSTRUCTIONS a. Tins 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 tins 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 ?t 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 auth°rized inspect°rs °n premises and in building f°r necesi~7.~,..~~ .Q.~ ............... (Signature of applicant, o~.,.n~ame, if a co~oration) .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N eofownerofpre ... ...... ....... .... - (as onX-fhe tax roll of l~t ~eed) If applicant is a corporation, signatur~ of duly anthoriz~d officer. FEE:_$' .............................................. NOTIFY ~B0~LO]NG D~,, A~ ~EN~ AT (Name and title of co.orate officer) 765-1B0;~ 9 ,ff~.~ TO ~. ~M FO~I 'TH~ FOLLOW ~,G Builder's License No .......................... 1 ~ FOR ~oU~g:r~ Plumber's License No ......................... 2 ROUG:'~ Electrician's License No ....................... z~. FINA~ 1. Location of land on which proposed work will be. Ooze, ~. O~.~{~g9 ~0T'R~;g(~tNg~<5;' ' 0::'..; ............. 7.(.. ...... .............. House Number Street Hamlet County Tax Map No. 1000 Section .... .~ ~ ....... Block ....... ~ .~ ...... Lot .... ~.~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .... ................................................ b. Intended use and occupancy .......................................................... 3. Nature Repair 4. Estima 5. If dwe] If garal 6. If busil 7. Dimen: Height Di~nen~ Depth 8. Dimen~ 9. Size of 10. Date o 11. Zone c 12. Doesp 13. Will lei 14. Name Name Name of Contractor ........................ of work (check which applicable): New Building .......... Addition ......... Alteration .......... .............. Removal .............. Demolition ......... ; .... Other Work. [ o,. ....... (D~'scription) :ed Cost ...................................... Fee ........ i .............................. '~' (to l~e paid on filing this application) . I ling, number of dwelling units ............... Number of dwelhng units on each floor ................ number of cars ' tess, commercial or mixed occupancy, specify nature and extent of each (ype of use ..................... .ions of existing structures, if any: Front ............... Rear ..... i ......... Depth ............... Number of Stories ' ions of same structure with alterations or additions: Front .......... i ....... Rear .................. ...................... Height ...................... Number bf Stories ...................... ions of entire new construction: Front ............... Rear ...... ......... Depth ............... lot: Front Rear : Depth 'Purchase Name of Former Owneri r use district in which premises are situated ....................... i .............................. 'oposed construction violate any zoning/aw ordinance or regulation: be regraded ..................... ...,~, ..... Will excess fill be removed from premises:_ Y~e~ >_c~No ,f Owner of premises ~,.c~ . . .~,,,. ,.q~'~ Address Phone No.7...q. .......... ,f Architect ..................... .'q.... Address ............. ~ .... Phone No ................ · Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. property lines. Give street and block number or:description according to deed, and st interior or corner lot. ' indicate all set-back dimensions from ow street names and indicate whether being duly sworn, de'poses STATE OF NEWcYOR, K,, , ~ S S COUNTY OF .~.... ' ........ ............... (Name of individual signing contract) above named· and says that he is the applicant He is the ............ .c~..~././.C-~.~ .................................. , .............................. (Contractor, agent, corpm'ate officer, et~.) of said owner or owners, and is duly authorized to perform or have performed the 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 of...~..~.. ..... , 19 .~..~ : ......' Notary Public .......... ..~~ ...... C°unty(~-~ 0 .. ..... :... ~ ~ ~ ~ ~ V~, , (Signature ;; ~ph~ant)