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Home My WebLink About14170-z ~0~ NO. ~ TO~N OP $OUT~OL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_ ~4~70 Z Permission is hereby granted to: ...... ........................ ....... ,o ........ .~.~ ~,~.~ ~....~ ....... .~..~.~.~.~ .................................................................................... County To,, Map No. 1000 Sec,on ..... Z/.~ .......... mo~k ..... /..Q'. ........... Lot No. ~..A..T./. ....... pursuant ,o application dated .......... ~.~.~.~--~ .......... .~.~... ......... , 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 ,pproved .(~/.y. ~.~.O .....~'19ff'~'eermitN°"/"~/'/'/~"'~' Disapproved a/c ........................... ~. ....... . k (Building Inspector) APPLICATION FOR BUILDING PERMIT Receiv?d ...... ~,.... ,~.. INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 {St 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 ihall 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 Regulahons, 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 dmit authorized inspectors on premises'and in building for necessary inspections. (Signature of applicant, or name, if.g. corporation) State whether applicant is owner, lessee, age~nt,~fchitect, en~neer, general contractor, ~ectrician, plumber or builder. ........ 0 W/t//. . tfapplicant is a corporation, signature of duly authorized officer. /, (Name and title of corporate officer) Builder's License No ..... ~.~f.-. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... I. Location of land on which proposed work will be done .................................................. House Number Street Hamlet ~ County Tax Map No. 1000 Section .... [~ -'~ Block tO Lot .~.:~ 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 .... ~.~.e ~. Tt~.~ .~. (l~.. d.~/.~//l'~...~. ..... ~~ ............... b. Intended use and occupancy . .q~ ...... ~ ................. ~e:~ ~ ................. Nature of work (check whi¢~ ~pplicable) New Building , · ,' ..... 'Add tion A~teratlt~n 7' -, ~ Repair . .~ll~a.0.~. g~mo~al ............. Demohtlon ............... Other Work. ~ .... ~ ~ ~-, ~ ~ __ , ~ (Description) Es;tima~gi~./~ ~ :~. ~.g ? ..... Fee ~.~ .................. k~ ~' ' ~ ~ ' ~, (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............. Number of dwe lng units on each floor ................ If garage, number of cars ...... ~ ................................................................. 6. If business, commercial or mixed ,occupancy, specgy nature and extent of ~ach type of use .................... 7. Dimensions of existing stmctures~ if any: Front ............... Rear ............ Depth ............... ' Height '. .............. Number of Sto~es ......................................................... DimensiOns of same st~cture with alterations or additions: Front .................. Rear .................. ~ Depth. .................... 5 Height ...................... Nu ..... tber of Sto~es ................. (Si Dimensions of entire new constmbtion: Front . ~ ~ear .. Deoth ...... ............... ....... . ........... 9. Size oflot:~ront ............ ~ .......... Re~ ..................... e ................ 10. Date of Purchase ............ ~'. ................ Name of Foyer O ~ner ...... m...~ ................. 11 Zone or use district in which premises are situated ....... 2. Does proposed c~nstruction violate any zoning law, ordinance or re~latim t: ................................ 13 ' Will lot be regraded .... ~ .d .... ' .~g... g~..~ Will excess fill be rmoved from premises' . Yes , No ~ ~ Nme or Owner of premises ~ .... {~~a~ess .~ 2~ ~ ~ ~. Phone No.~, ~7 ~ Nme of Architect .......... ~ .............. ~ Address ........ ~... Phone No ............ Nme of Contractor .......... ................ Address .................. Phone No ................ PLOT DIAG~ Locate c!e~ly ~d distinctly ~1 bulldogs, whether existing or proposed property l~nes. G~ve street ~d block nhmber or description according to deed, inte~or or corner lot. STATE, OF NEW YORIQ,/% ... ,~,~ coeoiY o?.., ! ~. (Name of individual signing o(ohtract) above named. -~He is the ............ . ........... ............................... I . i ~ ' . ] (C~A~a~.tor, agent, corporate of'fi, of said owner or owners, and is dulyi authorized to perform or have perform application; that all statements contained in this application are true to the b, work will be performed in the mannerlset forth in the application filed therewil Sworn to before me this ..... , . .'.°~. '~.~iL.% .... dali; ~ ....... 19 ~.~. Notary Public, .... ..... .~l~~i////.~W,!. ' ... County and, indicate all set-back dimensions from md show street names and indicate whether rn, deposes and says that, pt6 is the applicant etc ) ~d the said work and to make and file this ~st of his knowledge and belief; and that the h.