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Home My WebLink About13773-z ]~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 13773 Z Dote Permission is hereby granted ~ ..~.~.~ ...... ~.~ .............. ~...~..~.~...~.~.:....I.~.a..~.. ~~ ..,.:o .~ ....... ~..~....~ ..... County Tax Map No. 1000 Section .....(~..~..J. ........Block ...... ~ .......... Lot No......~..~ ............. pursuant to application doted ....... ~J ........ ~..~. ........., 19.'~.~., and approved by the Building Inspector. Building Inspector Rev, 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 76§-1B03 ..~& ~ · o,~ ..X).., 193~. Permit No. } .~-)..~ .... Received ........... ,19... (Brfilding Inspecto[) APPLICATION FOR BUll, DING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~. The work covered by this application may not be commenced before issuance of Building Permit cl. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant· Such permit 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 been granted by the Building Inspector. IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to inspectors on premises and in building for necessary inspe~ns. (Signaqfure of applicant,t6'r name, if a corporation) · ~ .v......,g~...~.~:...~?. (Mailing address of applicant) whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. pplicant is a corporation, sigfiature 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 .................................................. ....... ~ ~ .¢..s~ ........ ~...~.., .~.~.. ~.. ................ ~.~..~.. ~ ~ .............. House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..'~,'~ .~ ...... Block ...... .~. .......... Lot....~..~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .... ~ ..... "' '~;c~ ~ k~ .... ; ...... ~~ .............. Intended u se and occupancy. ~. ~~...~.~' ~';J,:~}d,;~ ,~t;,~h. ~r ................................. 3. Nature of work (check which apElicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work,..~~. .... %e riptio n) 4. Estimated Cost . . ~. ~ .............................. Fee~ ~ - - - ~-' (to be paid on filing this application) 5. If dwelling, lumber of dwelling units ............... Number of dwelling units on each floor. ............... If garage, number of ears ...... i .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dhnensions of existing structures; if any: Front ............... Rear ..............Deptli... ........ ... . ti{light ............... Number of Stories ........................................................ Dmlensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... ~. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constr~ction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ...................................................... 9~ Size of lot: Front ........... 10. Date of Purchase ........... l 1. Zone or use district in which pm~ 12, Does proposed construction violt 13. Will lot be regraded ......... 14. Name of' Owner of premises ... Name of Architect .......... Name of Contractor ......... Loeate clem'ly and distinctly 'all property lines. Give ~treet and block r interior or corner lot. .......... Rear ...................... Depth .................... ................. Name of Former Owner ........................... aises are situated ................................................... te any zoning law, ordinance or regulation: .............................. .. .................. Will excess fill be removed from premises: Yes No ................ Address ................... Phone No ................ ................ Address ................... Phone No ................ ................ Address ................... Phone No ................ PLOT DIAGRAM buildings, whether existing or proposcd, and, indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether STATE OF NEW YORK, S.S COUNTY OF ................. i umme ofind' '~fl signipg contract) above named. and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owncrs, m~d is dul~ authorized to perform or have performed the said work 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 mmmerl set forth in the application filed therewith. Sworn to before me this Notary Public, .................. County No. 4022803, Surfak Term Exp ~'e~ MIr~