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Home My WebLink About14202-z FOEM~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_o Permission is hereby granted tot ~ ....... :' ....... ~..q......./~~....D.~,. .............. ........ .~.~.~,.~.~.~.,-= ~.'.,./,.,,....../, /..~ /./ ,o ........... ~,~.~.~....~c~.~ ......... .~..~.~c....~..~ ........ ~..~..L/.~,,~.. ..~.~...~.r,~.. ............ County Tax Map No. 1000 Section ...~........~,. ...... Block ....~.....'.~.. ........ Lot No....(~./../. .......... pursuant ,o application dated ..... .~.~....~..,~.......~.....~.. ................. , ,gZ.~..Tand approved by the Building Inspector. Fee $ ......... Building Insl~ector Rev. 6130/80 0 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 pproved . .... l r. ee it Disapproved a/c .......................... ~ ...... ................ '777..~...~.¥7 .~. ....... ~"~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building inspector, with 3 ets 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 hall 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 hall 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 luilding Zone Ordinance of the Town of SoutholdiS~ffolk 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· 'he applicant agrees to comply with all applicable laws, ordin~a¢ces, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. .-.;- ........... (Signatuf~bf applicant, or nlffne, if a corporation) .67,3 .~. L .~.~.~/. t~ ~-,..Xo.~.k.~, ld. BY. ~! .~.'2 1 .... (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises .....~.. ?.,....~..'[ I. l,..~..r~... ~. P.,i · .e~r~.. ........................................ (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....~.~..6q. 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 .... ~ ............ Lot..~..'*7 ].l ......... 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 ..?.D.~..~.,~.O3. ].c4. O.J.: ........ 3. Nature of work (check which ~pplicable): New Building ..... ' ..... ddition .......... Alteration .... i i. :.. ~ Repair .......... · .... Removal .............. Demolition . .~ ........... Other Work..~e,~.c,~_~, · · ~[~ J~ _~t , ; J (Description) 4. Estimated Cost ~.~?~4'-: '. r , ~ ~ (to be paid on filing this application) '* 5~:'~If 'd~lliff~',~nhmber o f dwelling units ............... Number o f d~elling units on each floor ................ If garage number of cars ' 6. If business, commercial or m~xed occupancy, specify nature and extent )f each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rea: .............. Depth ............... Heig~t ............... Number of Sto~es ....................................................... D~ensions of same structure With alterations or additions: Front ................ Rear .................. Depth , HeiSt ~umber of Stories - ~ 8 Dimensions of entire new consimction: Front Rea~ Depth Height ............... Number. of Sto~es ......................................................... 9 Size of lot: Front Rear Depth 10 Date of Purchase ' Name of Fome Owner 11. Zone or use district in which p}emises are situated ...................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulal ion: .. ~.~ .......................... 13. Will lot be regraded ........ ~ .................... Will excess fil )e removed from premises: Yes No fp 14. Nme of Owner o remises . .~ .................. Address .................... Phone No ................ Nme of Architect ......... ...... . ............ Address ................. Phone No ................ Nme of Contractor ¢~. ~Q~l~ ....... Address ................. Phone No. ~.[~g~ .... PLOT DIAG~ Locat~ cle~ly ~d dist~cflg a bufld~gs, whether existing or propos t, ~d, indicate ~1 set-back d~ensions from prope~y ~nes. Give streeI ~d blocl, number or desc~ption accord~g to dee~ ~d show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ........ [ ......... .. ·:: ...... .1.. .................... being duly ss 'om, deposes ~d says that he is the applicant (Name of mdiwdual s~gmng contract) above named. He is the .....................~ .................................... , ............................... (Contractor agent corporate of ¢t9 ) of said owner or owners, ~d is dully autho~zed to perform or have perfor ned the said work and to .m~e and file this application; that ail statements confined ~ this application are true to the best of his knowledge and belief; and that the work will Be perfomed in ~e m~n~r set for~ in the application filed there~ ith. Sworn to before me this ........ : .... d~ .~...day ..... lmm [~pir~ ~h ]~, 1~ ' (Signature o; applic~t~