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Home My WebLink About14133-z FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NR 14133 Z Permission is hereby granted to: , ~'~ ~ ......... ..... .... ...~......~......~ .......... A ........................................ ..~~~...~.:~.:.....u..~..~..I .......... ,o ..~~....~~....~.~.~..~...~.~.....~....t~..~ .... at premises located o~ ~...t..'~...~.'~1~.....~..~~~ ...... ...'~.....a~'~}..~...~.~ ........ County Tax Mop No. 1000 Section ....... .~..~.~.. ...... Block ....... .~...~.. ....... Lot No ....... .,~..)...! ........ pursuant to application dated .......... ...~. ,..~...~,..~.. ................... , 19,.,~.,~..~,,~ and approved by the Building Inspector. Building Inspector Rev, 6/30Z80 Cll FEN£~E S ~ge NO. of Pages hereby , h~rn,sh mat, rial and iai:x), complete ~c(ordance w~* above speedboat*ohS, for !he ,~um of' J and condlt.nS are sat,sfactory and ere hereby accepted You are authouze~ S,~.ature&-_:~PT ' ~.. ,-~'~ .... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ...... ~.~.. , 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, ~. 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. (Signaturo4~f applicant, or na~e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gineral contractor, electrician, plumber or builder. , .. (as on the tax roll oi:liff~s~ · · , If applio~nt'is a corporation, sigha'iure'0f duly authorized officer. , NOTIFY BU~LOI~ DEPARTMENT AT 7~o-~a.'~ 9 &~ TO 4 PM FOR THE (Name and title of corporate officer) ................ Builder's License No ................... 2. r¢()~..'.,.?}~ .... ting ~ PLUMBING Plumber's License No. 4. ~:: ,'~",~ :.3T,qUC:"!O~,J MUST Electrician's License No. ALI,: ....... THE ~EQUI~Efi.~IE[~ITS Off: THE N.Y Other ~rade's License No ...................... STATE CONSTFfUCTIOI,4 & CODES, NOT RESPONSIBLE FO~ 1. Location of land on which proposed work will be done ............. . .~. !G.N..O..~ .GO~/RUCTIQN ~ft~O~,. ...... House Number Street Hamlet County Tax Map No. 1000 Section O~ Block O~ Lot O Subdivision ............................... ' ...... Filed Map No ............... Lot . ~ ~. ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Repal~ ~ .[ ~j .... RemOval 4. Estimated Cost ..... )..~.~. iO 5. If dwelling, number of dwelling[units Nature of work (check which applicable): New Building .......... A, ldition .......... Alteration ..... '.. [.. ........... Demolition ............. Other Work. r.~q~ ....... ~ ~,,ff' (Description) .................. Fee , c~ o ~" (to be paid on filing this application) Number of d' ~lling units on each floor 10. I1. 12. 13. 14. If garage number of cars ~ 6. If business, commercial or mixe.!d occupancy, specify nature and extent f each type of use ..................... 7. Dimensions of existing structures, if any Front .. Rear ..... Depth ... Hetg t .............. Number of Stories. . ................... D~nenslons of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... N umber of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear .............. Depth ............... l-Ieight ............... Number of Stories ....................................................... Size of lot: Front i pth ...................... Rear ...................... De ...................... Date of Purchase .......... I .................. Name of Former Owner ............................. Zone or use district in which pr~mises are situated ........................ Does proposed construction violate any zoning law, ordinance or regulati ~n: .... ~.~I, ......................... Will lot be regraded ........ Name of Owner of premises ~ ~ ................. Address ........ Name of Architect ...; .... il 4 . Addressl.,~t~0~: Name of Contractor ~ ~ .~.c} ./. ............. PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or propose property lines. Give street and blocklnumber or description according to deed interior or corner lot. e removed fro~ premises: Yes No t~'~,.~m~'0.¥hone No..2~ 5/.7 .~.q ~SD. ~. ........... Phone No ................ ).r:.~ol~.. Phone No.-/~,5':..~.q .~.O... 1, and, indicate all set-back dimensions from and show street names and indicate whether I COUNTY OF ........... ,i · .... . .'~..O.5.. ~./?~...~.:./5/..O././.~.~4/. ............ being duly sw ~'(Name of individual signing contract) above named. He is the .................... C O.A~. ~ .~../f~.~.aT~,~5 ...................... . ............................ (Contractor, agent, corporate off cer, etc.) of said owner or owners, and is duly. authorized to perform or have perforr application; that all statements contoined in th!s application are true to the t work will be performed in the manne~ set forth in the application filed therew: Sworn to before me this ~rn, deposes and says that he is the applicant ted the said work and to mal~e and file this est of his knowledge and belief; and that the th. '5:' (Signature of applicant)