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Home My WebLink About14397-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) NB 14397 Z Dote ...........................................19 ....... Permission is hereby granted to: ...... ........ ................... Cut~ko~ , )U,K ,o ............. Q.~.~.~Z~.~:~ ................................................................. at premises located at .................................. ~ ........................................ .~. .................... Coun,,,'ro,~ Mop No. ,000 So~,,on ........ /~ ...... B,ock ............. Z ..... Lot No. a- pursuant to application dated 10//~' 19...~....~., and approved by the Building Inspector. Fee ~ ........................ Building Inspector Rev. 6/30/80 MILy DWIZLLIIVG ONLy 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL °~OUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined ................. 19... ^pproved ..... /o.1~.:...., ~9 ~.:Pe~mit No./~.'.z?..7. ? Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) ........... rur~ BUiLDiNG PERMIT INSTRUCTIONS a. Tiffs 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 us~4 in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspecto,r. 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 inspectior~g~t~ ~Z~d"Q~ ~' r · ....... '../. ~,~ ~,.~. w~..-, ~z.~ ............... (Signa~re of app_lj,can~,{ffr name, if a cqrpo tion) ~.,o.,$.~.~.. 1~.;.?.. ~/.~. ~,.~./././~...r}~ ..... (Mailing address of applicant) Star, whether appli~nt is~ owner~, lessee, .agent, architect, engineer, general contractor, electrician, plumber or builder. n .-~. ¢. · . ............. ~ .......................................... ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) , ~, c.-L~: ~,-~-' ~'--" ' ~ Builders License No..~. .... ~ ....... , ........ ~' n , ~/L~'"""' ] Plumber s License No. ~~~.. ~X~°~. · Other Trade s License No. {>~ .......... 1. LoCation of land on whiCh pronosed work will b~ done .................................................. .... ~t~.5. ............ ~ ;~,(a~...¢~,. ................... ~d;e~ ..................... House Number ~ Street HamleO 7 ... ..... ........ .......... ~ubdivision..~ ~.. ~&~ ~ } } ~ ~ ~ ~ ~ } } } ~ } ~ Filed Map No. ~.g~.t~ ...... Lot .... .~ ........ 2. State existing use and occupancy of premises and)ntended use~nd occupancy ofprogosed construction: , .. L :~,, ~ ~ cj~ ~. ,~,~,~,~,,~ o~,~ .~::. ,.~... :~,, .,.~:.~,~.. ,.. ............................... 10~ 11~ 1~. 14. 3. Natur~ 9f~wqr~ (check which ap~licabi~e)~i' Building .......... Addition .......... Altera ....... ~'.. R~r I~ ~ l..,~, Removal .............. Demolition .............. Other Work. ~,~.,~ ...... ,, ,,;. ' ~Desc~ption) Estimated Cost :-2 Fee , ~ (to be paid on filing this application) 5. If dwelling,, number of dwelling ~nits ............... Number of dwelling units 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, D~mensmns of ex~st~ng structures, ~f a y: Front ............. Rear ....... Depth Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... .. HeiSt ...................... Number of Sto~es ...................... ~ 8, Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tteight ............ x.. NUmber of Stories ............................................. Sizeoflot: Front .... ~q ............ Rear '" ~'/'. .......... Depth . Date of Purchase ............................ Name of Fo~mer Owner ............................. Zone or use district in which premises are situated .............. ~i ...... ~" .................... ' ......... Does proposed construc~n viohte any zoning law, ordinance or reg etlon: .~ ........................... Will lot be regraded . .~ .~ ~.: .~ ~.r ~'~: ._~ ...... Will ex~ess ~il bg r~oved from premises: ~ No Nme of Owner of remises ~ ~ll~h~ Address ~~ . .. Phone No. . N~e of Architect ~ , Address .... ..~. ....... Phone No ......... ~ ..... ~ of co~t~a~to/~t~t~ ~ ~G5 ~ Address ~ .... ] ........... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-baak 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. STATE OF NEW/YOI~I~,,. /// , S S COUNTY OF ~."7~.. ' ... ~...~.~..~..~..~./.~.. ?... ?~.G//J.©.~./7?./. ........... being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named. He is the ................ & ~ A/' ~{~./c) .................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly 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 manfier set forth in the application filed therewith. -Sworn to before me this , "oIAnYt~Jnl. Ic, sta~o~t,~vv,~, ~ (Signature o~applicant)