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Home My WebLink About14070-z I~RM' NO. ~ TOWN 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 14070 Z Permission is hereby grante~Lt~, ....,~,,.o..~....,...'~.,~~....~.?..... ...~....~~~....~....~........!..a.~..I. ..... ,o...~.~......~......~.~....~...~ ....... ~......~...~~ ............................... ~'~ ........... ;r/.fiZ'"' ........ , ............... Fk ....... '~T'"""~" "2- ~'~ ............ at premises located at ..~...0.._~...[...~.~.~.....~.... ....... ~..(~.... ..... County Tax Map No. 1000 Section ..... ~).~.'~....~'.. .... Block ....... ...~....(~. ...... Lot No ........~.....~. .......... ..... ~t~x%~ ....................... , 19..~...~..,- ~' and approved by the pursuant to application dated .~..~. Building Inspector. .......... Building Inspector Rev. 6/30/~80 'FORM NC). 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ..............Ak,~v~ /..~,., 19 .~.~. Permit No.. l..q?.?.9 .~.. Disapproved a/c ..................................... (Building hlspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG, [~EP £, Received ........... ,19... 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 Bull, ding 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. (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. ...... .... ..... ......................... Name of owner of premises ............................ · ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~..O.~...tl..~.~.lJ,.~[?)?r ........ Plumber's License No..~./.~ ................... Electrician's License No..~.[~ ................. Other Trade's License No....~.{..~. .............. 1. Location of land on which proposed work will be done. C~.5 ..... .~..(~. l ~ ~.~-L,) .... · · .~. · ............. House Number Street Hamlet County Tax Map No. 1000 Section ,,5-,~ Block b Lot .~.0... Subdivision ..................................... Filed I~lap 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 .~. a.S( ~a0tA .~:!,~e~ ~', :, .:',.., .... ,. , ,,' 3. Nature of work (check which applicable): New Building ..... ' .....'Addition .......... Altomt/on . ~ .... j . 4. LmmatedCost ...~-6.) ..... {]C9.~ ................... Fee ............ , '~ (to be paid on filing this application) ' I ' d Iii hr 5. If dwelling, number of dwelling units ............ Number of we ng units on eac ocr ............. If ga · rage, number of cars .............................................. ,. ..... .. .. · .... .. ... · · 0 flY h typ 6. If business, commercial or m~xe occupancy, spec nature and extent of eac e of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear ............ :.. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure wkh alterations or additions: Front ................. Rear ................. D pth : Height ' N mber of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth .............. 9. Size of lot: Front ........... I ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of FomTer Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~..0. ......................... 13. Will lot be regrad~d . IM'/5> .... l ................... Will excess fig b.e rem~vec}, fl~9~n premises: Yes 14. Name of Owner of premis..es ~.~.q..0.~..~...t~.. .... Address .Z°3P..~..~.~.q~°...~?..~.~.~.~'Phone No..7~.~.-.11~t~ .... Name of Architect . ~./. ~ .... , ................. Address ................... Phone No ........... Name of Contragtor ../,)[[~-. ................. Address ................... Phone No. '.. ' i i ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate 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. ......~.,.~.C~}~.. ~.~~ ....... ~'. .... being duly sworn, deposes ~d 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, ad is duly authorized to perform or have peffomed the said work and to m~e and file this application; that ~1 statements contorted ~ this application are true to the best of his ~owledge and belief; and that the work will be pbrfomed in the m~ner s~t forth in the application filed therewith. Sworn to before me this Sc~ (e: 40'--' I"