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Home My WebLink About13871-zTOWN 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) N9 13871 Z Pem~ission is hereby granted t · .:' ......... 1 N~ ' ' ' ~at premises located at **~..k~**....~....i?~****~. ..................................................... : ............ ............. ~' .......................................................... ~ ...g .,~******CZ~**......~.~ . ** ................ County Tax Mop No. 1000 Section ...... /.....~....~. ....... Block ....... ~ ........... Lot No ......~ ............... 'o application dated ....~.....'~....~..'~. .................... , 19.?...~..~., and approved by the pursuant Building Inspector. Building Inspector Rev. 6130/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ~ ...... , 19 ~... l .{e.., 19~.~. Permit No. ]..~.~..r~l ~ Approved Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 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 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 and in building for necessary insp~.n~ d~ " /~, 0, (Signyre of applicant, or name, if a corporation) ,¢o4 w,z, . ,,'---?..77..0. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~./~ ./~../%/.... ~...'../-.'.~. 9~ .e.~.~ ...................................... (as on the tax roll qr la~ee~ Ir applicant ~s a corporatmn, sxgnature or duly authorized officer. (Name and title of co,orate officer) 1 Location of land on which proposed ~ork will be done... ~.~ ~ ~~. ~.~.~.~ .... House Number Street Hamlet County Tax Map No. i000 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: ~. Existing use and occupancy ....... ~..~....... ' .............................................. b. Intended use and occupancy ....... ~~ ....................................... 3. Nature of w~o~k (cl)~qk which ipplicable): New Building ..... ' ..... Addition .......... Alteration Repair .... ff .~..,, ~ ..... Removal .............. Demohhon .............. Other Work .............. ~'- ' (Description) 4. Estimated Cost ~ o c)i o cD 'I '-' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ... i ..................................................................... 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 ............... Nmnber of Stories ................. Dimensions of same structure ~ith alterations or additions: Depth .................. i .... Height 8. Dimensions of entire new conitruction: Front Height ............... NUmber of 9. Size of lot: Front ......... I ............ 10. Date of Purchase , 11, Zone or use district in which premises are s~tuated 12. Does proposed construction' ~ 13. Will lot be regraded ....... i ................. 14. Name of Owner of premises I Name of Architect ........ i ............... Name of Contractor ....... ] ................ from premises: Yes:':~'(No] ..Phone No ................~ ............... Phone No ................ ................ Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and lilock number or description according to deed, and show street names and indicate whether interior or corner lot. ·_ , STATE OF NEW YORK~ . cou~rv OF~ ~.~ W.~ o~ ~C ~.~ ' ............. ~(Name of individual signing contract) ......... being duly sworn, deposes and says that he is the applicant above named. He is the ..... 0. ~.~ .~. ~...~ .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is drily authorized to perform or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the mmmer set forth in the application filed therewith. Sworn to before me this ......... ........ .... ........ . N0, 4707878, Suffolk C0¢nti ...... I