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Home My WebLink About13934-z FOB~ NO. fJ 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) NO_ 13934 Z Permission is hereby gra_~-fio: .... ~.~.....~.~ ............................... .; ......... ...r~.~.,...~.:~.;.....~L~...~.. ,o ...~ ....................................... ~ ...................... .¥.~....~ ..... ~..~ at premises located at ....~..~...:..)..~.~...~....~ ........... ....................... County Tax Mop No. 1000 Section ..... J..~...cj ........ Block ..... .(~...~ ...... Lot No .......C] ................ pursuant to application dated ....... ..~..~ ..................... , 19.~.~ and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 BUILDING DE"ARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Approved ~. .., 19~( Pemit No. ~ g~. ~.~.~ Disapproved a/c ..................................... (Building Inspector) ~PLICATION FOR BUILDING PERMIT TOWN OF $OUTHOLD Received ........... ,19.., INSTRUCTIONS 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 a~eas, 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 shall 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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ~ h~l.A.~.r'~...-,, .~.~.O..: A.~..~....--~.~,~3~.'~ ................................... (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'~ License No ................. ~,./; ..... Plumber s ~icense No ......... ....~ ......... Location of land on which proposed work will be done .................................................. ................................ ~.A) y(.~.., de~ /'r),z/77/?u'c:/d House Number Street Hamlet County Tax Map No. I000 Section .... (i,~.~ .......... 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 ........... ~.. ..................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work.. f.~..~..t:~. ...... ~! O ' ~'"'~ (Description) 4. Estimated Cost ............................... Fee ...................................... (to be paid on filing this application 5. If dwelling, number of dwelling units ..... ..-7-7 ....... Number of dwelling units on eaeah floor ..... --Tz.. ......... If garage number of cars 6 If b in ci 1 o mix d 9ccupancy specify natu e and extent of each type of use '-- · US eSS, commer a r e 7 ' ' ' !if any Front Rear Depth · D~mensmns of ex~st~ng structures ............................................. Height ............... Number of Stories ........................................................ Dimensions of.same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i' Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ! Rear Depth 10. Date of Purchase ............ I ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viola're any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i .................. Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' Address Phone No Name of Architect Address Phone No Name of Contractor i Address Phone No PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ........................... ~ ..................... being duly sworn, deposes and says that he.is thc applicant (Name of individual sigmng contract) above named. He is the .................... ~ .................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dDly authorized to perform or have performed the said worl~ and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworn to before me this ' ........................ day of. (¥t,..¢2~ ............... 19 .frS."- Notary Public,. ~U[k[U iq ~t)[ V0[" ''~'~ ~. ,0~.. ..... Count~ ~ .~...,~. ~...~,.., b/0. 4707078, Suffolk,ICoun&~ Term Expires March 30, I9~')