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Home My WebLink About14061-z ZI'OR'M' ~O. ~ TOW'N OF $OUTHOLD BUILDING DKPARTMI:NT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14061 Z Permission is hereby granted to: .... ........ ..~.~.~.....~....~...-. ....................... .... ~ ....... ~.:~:.~. ............................... , ,o ..~....~...L~.~...~/~.~....~ ............................ ~ ........... at premises' - ---'located at ....,.~..~..~...~..~......~.~....~...~.., ........ ...~.~ ............................... County Tax Map No. i000 Section .... .,.(~....,~.,,,C~,. ...... Block .......(~......~:-... ...... Lot No.......~.. ............... ..... ~.~'~J~ .................. , 19..~.~., end approved by the pursuant to application dated ..~...~ ~ Building Inspector. Building Inspector Rev. 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..3.t4<l~&".~.~.., 19'~ .~f Approved . . . ~.kJq'~°-..~.~., 19 ~.~. Permit No..~.~ .~..~.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 promises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tins 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 construcQon of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances code, housing co__.d~/9 . /) ~and regulations, and to admit authorized inspectors on premises and in building for necessary ¢' ~~ or name, if a corporation) .... ~Mailing address of applicant) electrician, plumber or builder. State whether applicant is owner, lessee, agent, Name of owner of premisesff'''.). If applicant is a corporation, signature of duly a (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ....... ~P22~','Y;. D' AS' N'OTED' ...... .... ^TE: ~rtatest de~) ~ x) r, . NOTIFv BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING ~bJ?ECTIONS: 1. FOLJN~A*ION - TWO REQUIRED F~R PQUR[D CONCRETE 2. ROU~TM - FRAMING R, PLUMBING 4. FIk~i- - Cqi''qTqll"';-lqN MUST BE ('",,'*m ..... - ~:~q C, 0. ALt. C"'>"~""C'IQN S')AI_L MEET Tt-lF PF' ...... :"*'~TS OF "FI'iF N.Y. STATF C~N~'TRUCTION ~ ENERGY COPFS. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done .................. DESIGN .OR CONSTRUCT. ION .EI~P, ORS... .... ............ - House Number Street Hamlet County Tax MapNo. 1000 Section . .~.0..~ .... Block ....... 3 ......... 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 ..................................................................... b. Intended use and occupancy .................................................................... 3. Natureofwor (checkwh~chapphcable):NewBuildmg .................. Repair ............. Ren3oval .............. Demolition ............ Other Work..2)¢¢:v:~W&)... 4. Estimated Cost ........................... Fee .................... ~ *~ (to be paid on filing this application) 5 If dwelling ' ' ' Number o'f dwelling units on each floor · , number of dwelhng umts .......................... If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dknensions of existing structures, if any: Front ............... Rear ........... ... Depth ................ Height ............... Number of Stories ......................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .......... N~lmber nf Stories 9. Size of lot: Front .......... ;. ........... Rear ...................... Depth ...................... 10 Date of Purchase ~ Name of Former Owner 1 1. Zone or uso district in which p~emises are situated .................................................... 12. Does proposed construction vi~late any zoning law, ordinance or regulation: .'.t~ ............................ 13. Will lot be regraded ........ i .................... Will excess fill be removed from premises: Yes No 14. NameofOwnerofpremises ..I .................. Address ................... PhoneNo ................ Name of Architect ......... ; .................. Address ................... Phone No ................ Name of Contractor .... ................ Address ................... Phone No ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicat~ all set-back 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 YORK, S.S COUNTY OF ................. ............................. ! ..................... being (Name of individual si above named. ning contract) He is the ................... (Contractor, agent, corporate officer, etc.) uly sworn, depo and says that he is the applicant 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 conltained 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, . ~..~.'. ~..'../:~.. V0F. i ......... NOTARY P[J[~klC, Slate oi New York ................ Na, 6?07878. Sufl01k CCtlaty., (Signature of applicant) lerm [apm~s March 30,! 19~ /