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Home My WebLink About13863-z FOB~ NO. e~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13863 Permission is hereby granted t~ , ~ . ........ ~,~.~.~......~...~ ................ ~.~.....~.:~.,.....l./....~.~..~. ...... ~ at premises located at ............................................................................................................................ County Tox Mop No. 1000 Section ...... ..C~.....~.~...~. .... Block ..... ..~....-'~ ......... Lot No ....... l..~...:..~.-~.. .... to application doted ..... ~ ........ L..~T... ................ , 19.~....~.., and approved by the pursuant Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined ~.. ! · .~. · -, 19~..k: Approve~.. )..~. .... 19~.~. Permit No./..~...~.(q..~'...~--. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF S..OUIH~OLD Received ........... ,q9... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 areas, 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(x ~-(~o~-%~ el-and in building for necessary in~e~tions.~~/.c:~...-- ,(~../.~_~. z:. ~. ;.~:~-:' ~ .'.. ~xC&&'NdX¥~ (Signature of~ aTtlcant, or name, ~f a corporatmn) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . >. ~" ..... r'. ........................ (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 .......................... Phunber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ................. .... . ................... ................ ........ ....... House Nmnber Street Hamlet County Tax Map No. 1000 Section . .~':.¢ ......... Block ..... ~)..? ........ Lot .... /..~.-.: ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~stin~ use and occupancy ................. ........................................... b. Intended use and occupancy .................................................................... 10. 11. 12. 13. 14. property lines. Give street and block interior or corner lot. Nature of work (check which ~pplicable): New Building ' Addition .......... Alteration .......... Repai{ .... ........ Removal .............. Demolition .............. Other Work.. ".bv:f ~ 'i' )i~'l"{" (Description) Estimated Cost ~/..5" ~ ....................... Fee ...................................... i '-' (to be paid on filing this application) If dwelling, number of dwelhng units ............... Number o f dwelling units on each floor ................ If garage number of cars If.buSiness, ' '' commercial or m~xed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structuTes, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure W, th alterations or additions: Front ................. Rear .................. Depth .................. ~... Height ...................... Number of Stories... ~,..:~.~ .............. Dimqns~ons ofent,re new cons)ruct~on runt .... ~/r..; f'~_<.~_..; Rear .....q/~....~.>m~=... ~:. ,,~'.. Height . Number of Stories I ........... '/ ..... S~ze of lot: Front .../~. ~.. 'i ............ Rear.../.5'.~. ............... Depth ....~.~. ~. ......... Date :of Purchase .. .... l.q. ~' ? ................... Name of Former Owner .... (..~.).. J~. A/J.c4. tV A/. ~... Zone~ or use district in which premises are situated ........... /. ......................................... Does proposed construction vi01ate any zoning law, ordinance or regulation: ........ .~..o ..................... Will lot be regraded ........ :..~ ..... , ............. Will exces.s fitl. be~re~oved from,ere, raises: Yes Name of Owner of premises . .i(~n~tT~.. ~ Address ~?..( ~. ~. ¢~4/.~..~.~o~e No. 7.~ ~. ~. 2~..~-... Name of Architect ........................... Address ................... Phone No ................ Nam~ of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all 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 (Name of individual s~gning contract) above named. t .......... being duly sworn, deposes and says that he is the applicant He is the ~7 ~ ~(/L , . ...................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this application; that all statements cogtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manger set forth in the application filed therewith. Sworn to .before me this ........................ day of ..... '~. ............... 19. ~. ~OTARY PUBLIC, Slme 9[ Nmw Yo~ . .L._,~-?~.~..~? ................ No. 41-98211§7 (Signature of applicant) CeO. Flied in Suffolkj County ~a~nmt~lon Expires Mar? 80, 195,(0