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Home My WebLink About14495-z I~O~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14495 Z Permission is hereby granted to: ..... ~.~H.~...c..~..~H~...~..T- ........ ~..,...O.. ........ .,..~..,(, ........ ~..~..~. ......... .......... ~.c~zm.~.z_~.....-.....~,..~ ....... ~o ...... :.:..~.....~ ...... .~..~.~.~..~.z,,.~....~.. ....... ~.(.-~,,~......~ ................. ...-/. ................. at premises located at ..~...(~.....~...~..~ .......... ..C.....f~........~-- ..~ ....................................................... .......................................................................................................... .~c~.T.e..~.~. ~..~..-..~!.-.~ County Tax Map No. 1000 Section ....(~....';~,.,..~.... .... Block ...~.,.~., .......Lot No..~...~...'r,.,.~.. pursuant ,o application dated _L.(...(...'~.C~. .................................. , 19~and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .. .... , Disapproved a/c . .~.~ ................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS I~I.DG. DEPT. TOWN OF SOUTHOLD Application No .................. 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 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 admit authorized inspectors on premises and in building for necessary inspections, ~ ,~/1 a ;-~ ~ '~ ?., ~-'~.~-~ {Q .... . FNC . qL ,/./. . " (Signature of applicant, or name, if a corporation) ..... ....................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant,)s-~ c ,o~i~ig~a{ure of duly authorized officer. ........ ¢ ............. (Name and title of corporate officer) Builder's LicenseNo .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. ~. .................... 1. Location of land on which proposed work will be done. ~...~ ...... ~ ................................... ..................... ....................... ...................... House Number Street Hamlet County Tax Map No. 1000 Section ...... .~..~.~ ....... Blogk .d:)7. .: ........ 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 ........................................ ~ y.x.tz~...C....~.~.~.o ............ b. Intended use and occupancy ........................................................... g'i Natare of work (chec which applicable): New Building .... ...... Addition .......... Alteration .......... ~ Repair ..... .~ ........ Removal ........... Demolition .............. Other Work .~iX.~.~ ........ , ' '~ :: ~' ~:--~( ........ ,,2, q,~w~tq~>' ) '~'~ (Description) 4. Estimated Cost . ~(? ....... .................... Fee .. ~... 7. ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling gnits ............... Number of dwelling units on each floor ..... :. .......... If garage, number of cars ~' ' 6. If business, commercial or mixe0 occupancy, specify natu're ~and extent of each type of use ........ . ............. .... f Depth 7. Dimension.s of existing structures, 1 any: Front ............... Rear ............................. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ,.. Height ...................... Number of Stories · . ........ 8. r)imensions of entire new construction: Front ... Rear . Depth ...... Height Number of Stories ~ 9, Size of lot: Front ........... ' ........... Rear ...................... Depth ...................... 10 [)ate of Purchase ' Name of Former Owner 11. Zone or use d~stnct m which premises are situated ..................................................... 12. Does proposed consftuction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No ~-~4. Name of Owner of premises A0~;Iye~ ~./~d~. f~. .... Address ................... Phone No ................ Name of Architect .......... i .............. Address ................... Phone No ................ Name 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 blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE 0~"I~EW YOI~eK,/,/ //~/ :o o ......... .M,/.~ .~.:..M~.7?x....&/fi~... ............. 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, etc.) of said owner or owners, ~d is du~y authorized to perform or have peffo~ed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed ~erewith. Sworn to before me this : .............. ~/ ..... da7 of.. ~~,%..., ~ lC 19 ' ~'~ NotawPublic, ..~.d.~.~ ....... Y~nt, .,~ I ~ umc, stot, ...... . ............ N,~. d72¢113' G, ucllif,od In Suffolk Count, .~~ ~ ~ (Signature of applio=t)