The URL can be used to link to this page

Home My WebLink About13748-zTO~N O~ $OUT~OL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13748 Z Permission is hereby gront~d to: ~ . ..g.~.....~.:~...~.,. .............................. ..... at premises located at ........................................... ..~.~:.~-: ....... ~ ~.~, ...s:.~.~ ........ Cou.tv Tox Mop No. Jo00 sect~o. .... .~.$.~ ........ B~o~k ..... .~.~ ........ Lot No ..... ~.]..:.~ ..... 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 xamined.. '.~'..0~.'..M'.I .... 19~..~. ipproved ...~.~v~4.x. !1.., 19 ~. f. Permit No. J .'~..~.~..~..~.. )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDQ. DEPT. TOWN OF 8OUTHOLD,, 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- 1ion. 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 all 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 .all have been granted by the Building Inspector. ', APPLICATION IS HEREBY MAI)E to the Building Department for tl~e issuance of a Building Permit pursuant to the ailding 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 hereha described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Imit authorized inspectors on premises and in building for necessary insj~ections. .. ..... ......................... ,(~'~hature of applicant, or name, if a corporation) rate whether applicant is owner, lessee'} agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No .......................... Plumber's Licehse .No ......................... Electrician's License No ....................... Other Trade's License No ...................... ame of owner of premises . . ,.~. ....... ' ...... '..~ .................... A~'~ i.t :..~..~$. ~¥ED .... ' (as6nthetaxr°ll°rlatestdeed)~ll ' :~~'~E: ~,~ ' applicant is a corporation, signature of duly authorized officer. ~EE: ~ ~ ~ ~Y: NO~'"~;)-II53]NG DEPARTMENT AT ~65-1802 9 AM TO 4 PM FOR ~HE 1. FOUN~A'qON - TWO REQUIREB ' ,~ ..... CONCRETE 2. RO~:,:..,- F~&,MIN" ~ PLUMBING 4. FINAl. ......... :'~N MUST BE C"' "'~ ,-'~-~. , r' O ALL CO~'~'~mJC-:tO~ c"?'J L MEET THE RFF"~u?:M:N-rS OF TI-~c N.Y, Location of land on which proposed work will be done. STATE CONqTRUCTI~N 8, FbF-~GY ................... ' ' NS?' ' ..... ........ ff.0.¢5 .7: .... 95 House Nmnber ..... ; ......... ' .... Street Hamlet County Tax Map N~ 2~-1000 Section:C(. 2-.~. ~ ........ Block .... ~ ~ .......... Lot...O.~g... ~ ....... Subdivision .... ~ i: .............. ,, .............. Filed Map No ............... Lot ............... (N~e) State existing use and occupancyTof premises and intended use and occupancy of proposed construction: a. Existing use and occupanby ................................................... b. Intended use and occupancy ..................................................... 3. N~ture,ot~wOrk,(checkwhtch apphcab]e): New Budding .......... Addition .......... Alteration ........ ~.. ' ~ ~ ~ '~ . ' (Description) ~ ,v~ :q .~ ].,, ] i ~' (to be paid on filing this application) 5. ~'~ll'ffi~/~lu~t'~f d~ell~ng units ..... / ......... Number of dwelling unit~ on each floor... / ........... If garage, number of cars 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~ensionsofsam~stmcture~ithalterationsoradditions Front ..~~ .... Rear ...... ' 8. Dimensions of entire new eonsVuetion: Front . . ./~. ~'~.., Rear . ,. ::'.: ........ Depth ./~. ~¢~V.. Height ... ~..~... Number of Stories ...' .' .............................................. 9. Size0flot: Front ...~ 3.9 .] ...... Rear...~.Q..~ ............ De~th ,~7. 10. Date of Purchase .... Z¢.Z.~ ................. N~me or Fomer 70.. ( Il. Zone'or use district in which p~emises are situated. ~¢.(Cc..~4~'.~ V ...................... 12. Does proposed constmction violate any zoning law, ordinance or regulation: ..~/.Q .......................... 13. Will lot be regraded .... ~. ~ ................... Will excess, fill be removed from premises: ~es 14. Nme of Owner of premises ~.fl.t. ~ ~.5cp ~,~.. Address ?.Z~/~?~.~q., .... Phone No.~( Y.(.~2-~ .... . ~s ........... ~ ..... ~o ................ N~e of~m~i ac ~m ' A~ss Phone No PLOT DIAGRAM Locate clearly ~d distinctlg ~1 bufld~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from property hnes. Give strut ~d bloc~ number or desc~ption according to deed, ~d show street names and indicate whether intefior or corner lot S~uc/~(~ry ~ ~ ~'--~ ~T~ATE OF NEW YORK, uOUNTY OF ..... 5 ........... L ............................. ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigOing contract) above named. 0 c:,t_i ' He is the (Contractor, agent, corporate officer, etc.) of satd owner or owners, and ~s duly auth. orized to perform or have ' performed the smd~ rwoi'lr and to make and file this application; that all statements coniained m this application are true to the best Of, hiS knbwledge and belief; and that the work will be performed in the manner set forth in the application filed therewith., Sworn to before me this .... 2.'¢ .~..T.et. ............. day o!f., .~..~.~>~...0..d..~.~ ...... 19 EUZa, BETH C. BEAUCHAMfl Notary Public; Stem of New ' No 300206540 Qualified in Nassau ?erin Ex~ires M~rch 30, 19...~ ..... County (Signature of applicant)