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Home My WebLink About14167-z FO~ NO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14167' Z Permission is hereby granted to: ...~.Z~:...z. ~z~.~. ................... :: ........ ........ ~../~z~z.....-...~,..-./... ........ /L.~...Z...... ro ........... C~.~...7.~c,c7Z.. ....... ./Z..~.C,.~ ................................................................................... County Tax Mop No. 1000 Section .~./.~. .............. Block ....~....~.. .......... Lot No....~.~/K~.....~....O...~ pursuant to application dated ....... jC.~,~... ........... /.~. ................ , Ig.Z~., and approved by the Building Inspector. Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 \ TEL.: 765-1803 / !Disapproved a/c ....... ~ ............. /~ .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. · Date ................... 19... INSTRUCTIONS i 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 ~t Certificate of Occupancy ~hail 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. .... . .TZ~../.~...~. 0 ~ ~ ............................ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) ~f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...~.. ~. ............... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ...... '. ~~. ............................. .. ................. ................. .................. House Number Street Hamlet County Tax Map No. 1000 Section ...(~{.~., ......... Block. "4-' ............ ! Lot o _ 'jo's'l: :5 ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... t/ .....~.O'~ ..... .~.. ?..~../.L/.4 ................ ~ ................. b. Intended use and occupancy ............. [.~..~.. ?/[. bB..(. ( ..... ::.?/[']iii?. :'!?!.. ~'~}'!~ ........... 84 !Nature of wor~ (efleck~hich ~pphcable): New Building .' ....A Repair .......... '.).. '. Removal .............. Demolition .. 4 Estimated Cost...~.]./~.~.' 5. If il~v~lling, number of dwelling units ............... Number of d, If garage, number of cars .... I ............................... -6. If business, commercial or mixed occupancy, specify nature and extent 7. Dimensions of existing structu~res, if any: Front ............... Rea ddition .......... Alteration ......... ....... Other Work..,f..~'.*e ¢.~' ...... (Desct r)tion) (to be paid on filing this applicatiov ) filing units on each floor ............... of each type of use ................... .............. Depth ............... Height ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front .................. Rear .................. Depth .................. ~... Height ...................... amber of Stories ...................... - 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height . .~.'.v.. O.; ....... Number of Stories ......................................................... 9. Size of lot: Front .......... . ............ Rear ....................... Depth ...................... 10. Date of Purchase .......... i ................... Name ofForm~ r Owner ............................. 11. Zone or use district in which piemises are situated ................ 12. Does proposed construction vi0late any zoning law, ordinance or regula 13. Will lot be regraded ........ ~ .................... Will excess fill 14. Name of Owner of premises -~rr.,.~e, .~. ~'en~,~..~.,'.. Address .O~t.~..: Namq of Architect ......... i .................. Address ....... Nmne of Contractor .2~?.~..~.-'~'~.,~.. ~-~, .~.~.~ ...... Address ... ~t ~ PLOT DIAGRAM Locate clearly and distinctly all build/ngs, whether existing or propos number or description according to dee. ,4' :ion: ............................ be removed from premises: Yes No t.~.~,.Or~'.~./'.'.. Phone No..~.~..~.-..:~.~..~.~.. ............ Phone No ................ V?: ......... Phone No..~.~. 7 ?.7~.~... ;d, and, indicate all set-back dimensions from and show street names and indicate whether property lines. Give street and bloc interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. .............. /.... ~.: .~'..o.~ ..~.....,~..*~...r~..~.~. ..... being duly (Name of individual sigping contract) above named. He is the .................................................... (Contractor, agent, corporate o: of said owner or owners, ~d is d~ly authorized to perform or have perfo~ application; that ail statements con~ained ~ this application are true to the work will be perfo~ed in the m~ner set forth ~ the application filed there~ Sworn to before me this . . 19Z? Notaw Public .... · ~..~:... ~.~ :~.. County yom, deposes and says that he is the applicant ricer, etc.) reed the said work and to make and file this best of his knowledge and belief; and that the tith. (Signature of applicant)