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Home My WebLink About13911-z FO]~M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13911 Z Permission is hereby granted to: "~'"~:-'~'~'~"~~.'"'"'_'"i~ .... .~~.~L..,...,u..:.~.:....~../.:~..~.~ ........ , . ~ ro ...... ~' ~ ° ~... ~ ............. ot premises located at ..... ~.~.~..~..~..~e. .................................................................................... pursuant to application dated ....... ................ , 19..~,.~.., and approved by the Building Inspector. Fee $.~.....:. ............ Building Inspector Rev. 6/30/80 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .'.7. } q~ ..... , 19~. .~. Permit No. t .~ {t .~... Disapproved a/c ................................... '/r~ : ........ ('l~ii~ing Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ;hail 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 3uilding 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. fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmit authorized inspectors on premises and in building for necess]hw inspections~ " L (S~gnaTfii:'~ o f applicant, or na~.~ f a corporation) (Mailing address of applicant) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~..o. ,9.~? ./9. ,Ztz'/J,~...,~4..e.~ ~7.:?~/:k/..~-J~_. ~... ~..~.~ ........................... (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 LicenseNo ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ..... .~..~.~7.~. i ..'~..~-'..~,72 . ./.~..~..: .................... . .E CT. . ........... .o. /24 c o .?. . .? .................. "'~ .................................. hamlet House Number Street County Tax Map No. 1000 Section /.~>..~ ............. Block ....~. ............. Lot...~..C:t. ............ Subdivision..o. ff'.~/v.,~, y..~.'.~.~.'~?.-~ .~ .................Filed Map No. ........ ' ~ -t 3 /... ......Lot / .7. ........ (Name) State existing use and occupancy of premises.and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... /?.4~ .t..o.O.~ .~'..~ .... ~...o.e-...~...~ ............................. , a. T:,,_ ..... , ....................... b. Intended use and occupancy ...................... ~.;¢'~,? ;.', ~¢~$',~'laa,,l ;4: ,,,~' 3. Nature of work (check which ~pplicable): New Building ..... ' ..... Addition .......... Alteratiofl.~tcr~,~T,,,~e~ Re~0ir ~ i~.. . Removal ............. Demolition .............. Other Work .,~.~z,,/~,.~ .... C~ *~ ~ (Desc~ption) 4. Estimated Cost oo ................. Fee ............... (to be paid on filing this application) 5. If dwelling, number of dwelliffg units ............... Nmnber of dwelling units on each floor ...... If garage, number of cars ... ~ .................................................................... 6. If business, commercial or mi~ed occupancy, specify nature and extent of each type of use ..................... 7. ~mens~ons of existing stmctu'res, if any Front ......... Rear Depth . e~ght ............... N~mber of Stones .................................................... Dimensions of same structure Wi~ alterations or additions: Front ................. Rear .................. Depth .................. ~ .... HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new con~tmction: Front ............... Rear ............... Depth ............... Height ............... N~mber of Stores ........................................................ 9. Size of lot: Front ...~. [ ............ Rear ../f~ ............... Depth .~ ................ 10. Date of Purchase ..... ~¢~.~. .............. Name of Fomer Owner ~. ~ ~ .~ ./~ ......... 11. Zone or use district in which ~remises are situated... ~.~ ~.~. ~.~. ~ ~ ............................ 12. · " ' ' Does proposed construction wolate any zoning law, ordinance or regulation: . .~ ........................... 13. Will lot be regraded ....... ~ ................. Will excess fill be removed'from premises: Yes No 14. N~eofOwnerofpremises~o~.~.~Address .~F.~*~PhoneNo~g.~ ...... Nme of Architect .......................... Address ................... Phone No ................ Nme of Contractor ....... ~ ~.~.~.~ ........... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly ~d distinctly ~1 bufld~gs, whether existing or proposed, ~d~ indicate all set-back d~ensions from property ~nes. Give street ~d bloc¢ number or desc~ption according to deed, ~d show street nines and indicate whether interior or corner lot. i ......... STATE OF NE~ COUNTY OF ..... F~ ....... S.S ..... ~e.~ ~. · ~ · ~ ~ .~ .W. ~.~ ............. being duly sworn, deposes and says that he is the applicant (Name ot5ndividual si [ning contract) above named. He is th i ~ .~ (Contractor, agent, corporate officer, etc.) of sam owner or owae~, ~d is duly authorized to perform or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ............... Nota~ Puklic ............... Cou ~ ~ ~ f~ ~ of applicant) Term ~ Ma~ ~ 1~~