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Home My WebLink About14238-z FOZlM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 14238 Z Date ..... ,R~ ............... Permission is hereby granted to: .... .~...~...~.~.~ ........................................... .......~ ~': ......... -' ~"' ................................................. ~.~.c~ ....~.... ...................... ' .~..~..~......~.......~.:..~.~...L....~:. J. ...................................................... 0 ~ ./..~... ,, ~ at premises located at .~. .............................................................. County Tax Map No. 1000 Section,~fl....~'....~.. ........ Block ...... ..C~......(~.. ...... Lot No ...... ]....~. ............ pursuant to 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.: 765-1803 Approved ~ .g.". ..... , 19 .~.~. Permit No).¢.&. .'g:. .~. .~. . isapproved a/c ..................................... ' (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ~19.. , Date .................. , 19... 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :atinn. 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, 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, ordinances, building code, housing code, and reg~ulations, and to [mit authorized inspectors on premises and in building for necessary insp~ctions.~ ,~ ,,~ d/~ ' (Signature of aJfplicant, or name, if a corporation) ....... f.. .0;. . . 74. . ..... . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Same of owner of premises .~./..~,d~.~...~.. ~.~....z~../~...f/. .D..~. ..................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on whichproposed work will be done ................................................. ............... ............ .,.r-... House Number Street Hamlet County Tax Map No. I000 Section ...... /.o~..~. ....... Block ...... ~ ........... 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 ........ ~ ............................................... b. Intended use and occupancy . z.~..~<.,: .~.... :x :-.q .'-:. .~-~ · · ~0~,~ ~- ;: .,"i ~ ..... 3. N ture of work (check which apphcable): New Building .......... Addition .......... Alteration ......... Repair .~.~., .~.. Removal .............. Demolition .............. Other Work.. (Description) 4 Estimated Cost .~. :/' .5.".~ O~ e . i ~' (to be paid on filing this application) 'i 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars ... i .................................................................. ,. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures,, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ........................................................ D/mensions of same structure With alterations or additions: Front ................. Rear .............. Depth ................... i. · · Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... 9. Size of lot: Front .......... i ............ Rear ...................... Depth ...................... ~ N rO 10. Date of Purchase ........ ~ ........... amc of Forme wner 11. Zoneior use district in which p~emises are situated ..................................................... 12. Does proposed ' " zoning law, ordinance or regulation: construction v~late any ................................ 13. Will lot be regraded ........ i .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Aq)IL}/. ~ ~./'~. ~.h ~ t~.. Address .~.rt,/~0. J'~t.r~ la~ ~Phone No. ~.q.~'F..'7/~.~. ,,R-... Name of Architect ......... i .................. Address ................... Phone No ................ Name of Contractor ' Address Phone No PLOT DIAGRAM Locate' clearly and distinctly a~l 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. STATE OF NEW YORK, S.S COUNTY OF ............. , (Name of individual sig¢ing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... i ........................................... ~. ........................ ~ (Contractor, agent, corpomt~ officer, etc.) of said owner or owners, and is ddly authorized to perform or have performed the said work and to make and file this application; that all statements coniained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . , . . .d, jf ..... ...................... , Notary Public, . .... .~..~.. ~ .... Count .... : (Signature of applicant)