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Home My WebLink About13755-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FI~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13755 Z Permission is hereby granted to: ~.,.....;.~.::...~.~..~~~.., ......... .~~:~:-~.....~.:.~.,. u...~.;.~ ........ ,o...~ ....... ,,, ..... .~...-...,.....~,....i~...~ ........ ut premises located at ....~..~......,.~......~...~~ ........................................................... County Tox Map No. 1000 Section ..... I...O...~.~.. ....... Block .....~..k ........... Lot No ..... .~..:..~ .......... pursuant to application dated ..... ..~.~.~....~,....~.. ............... lg.~..~'m'~", and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 $.$ 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1B03 ~xamined . .~.0~-~ .1. ~., 19 .~.&.~' [pproved ...~..'..O~...c~...I..~.., 195 .~. Permit No. J..~..?.~.'~.~. ~ )isapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . ./~..~/..~ 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 ir areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- iation. 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 xall 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 uilding Zone Ordinance of the Town of Southotd, 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~d~regulations,.'and to dmit authorized inspectors on premises and in building for necessary inspe, zalZ~s. /2 ~1 /// * ../¢. .......... ':' ..... · --- '.../ ....... (Mailing address of ~pplicant) ~' is~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ltate whether applicant of owner of premises ..... ....................................... ~ (as onXlxe tax roll or latest deed) f 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 which proposed work will be done. ~.t:PJ: ~.~. .... ........... .~. .~ )'T./~. ~-.L?.. . . ~.. ('/..~.. ..... ~. /. ? .... ~t~ee/'~ l')/' ~'-/~ ..... ~' .................................... House ]~f~fim ber Hamlet County Tax Map No. I000 Section [C-b~ Block I 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...~.-R,5 /: .~.~. ~ :TLJ: ~,./ ................................................ b. Intended use and occupancy . ..~..~..~'~/..-4.~). ~./. ....~./.'.' .~.a/. . . ...~.-P./Z-Z .C..~. .................... 3. Nature of work (check which applicable): New Building Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ~..--~.Z?. ~ .~. ; i~'~] 4~'P~m (Description 4. Est~matedCost ..... ~: Fee . ~ ~ ..... ' q~ (to be paid on filing this application) { ' ' f& llih~ 5. 4f~.welling,.number o e units ............... Number of dwelling units on each floor ................ If garage, number of cars .... : .................................................................... 6. If business, commercial or mm~d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctu[es, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .......................................... D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ........... ~ . Height ...................... Number of Stories . . 8. Dimensions of entire ~ew cons}~ctlon Front... ZO~ ....... Rear...~ .......... Depth , Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ............ Rear Depth 10 Date of Purchase .i Name of Fomer Owner 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed constructi%nxiblate any zoning law, ordinance or regulation: ........... ~ ................ 13. Will lot be regraded . . .~., ....... ~ ........... Will excess ill be rei~oved from premises: ~ ~ Yes 14. Nme of Owner of premises . .i~.~ ~5.. ~Address ~¢~.~..~e'~ ..... Phone No.~ ~... Nme of Architect ......... i · ' ' ~ .......... (.. Address . . .( ............... Phone No ................ Nmn~ of Contractor ....... : .................. Address ................... Phone No ................ 'Locate clearly and distinctly all property lines. Give street and blocl interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, ' S.S COUNTY OF .................. ..... ....................... ; ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements coqtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mamter set forth in the application filed therewith. Sworn to before me this ................... day of ........... ,19 Notary Public, .. ~ . .,., ............. County HELEN N0, 4707878, Suffolk Cctmty