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Home My WebLink About13670-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PP~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ _ . cou~ Tax Map .o. ~000 Se~.o~ ~..~ .... .~ ..~ ...... ~o~ .o.~ .......... pursuant to application dat~ ~......~ .............. , l~%nd approv~ by the Building Inspector. ~ Fee $ ....................... Rev. 6/30/80 FORM N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1803 Examined .~t~L..... ff.F. .... , 19~.~-' --~ Approval>.-.".'.[/. ..... ~'ermit No./(.~.~/..~/. Disappro'J~d a/c ......... ~ ........ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG, DEPT. TOWN OF SOUTHOLD Received .......... ,19... Date .. ~/.o?: ........... , 19 .~.3..'~ 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 regu!ation_s, and to admit authorized inspectors on premises and in building for necessary inspections. TWIN FORK FENCE COMPANY ................. ~-O. Boa 47~ -. North' ~aaa ......... (Signature of appliq~llli~it~J~l~,ar~ l~b~iSUration) ................ ??..5'..aY.-..q?. 72 ................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ......................................................... Name of owner of premises . ~../G.~L. (.z5 ..... /-'..' .... .~...0..~...O..~.~./. ...................................... (as on the tax roll or latest deed) If applicant is a corporation,~ignature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~4~) ~/ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ......................... ...... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~.2 ......... Block ~ Lot ~7 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b Intended use and occupancy 75e'~e 4. Est' ?st .....¥.g4l[0..0 .......................... Fee ........ ........................ *~ !0'4 ,' ! (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 ' if any: Front ..... Rear .............. Depth structures, ......................... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear ......... :X ....... Depth ................... I... Height ...................... Number of Stories ......... . .......%. .... 8. D~mensmns of entire new cons~ructmn Front .......... : ..... Rear ............... Depth .............. Height Number of Stories 9. Size oflot: Front .../?:?'~ ..... ' 10. Date of Purchase .......... i ................... Name of Former Owner 11. Zone or use district in which p~emises are situated .................................................... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded .... ..... ! ........... : ........ Will excess fill be removed from premises: Yes ,_ No 14. Nmne of Owner of premises Name of Architect ......... i .................. Address ................... Phone No .............. ;. PLOT' DIAGRAM Locate clearly and distinctly al~ buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and bloc~number'V or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ........... .~. t..r(O..~ff...G..,5'?~.~..6..r-d-??, t:~. ........... being duly sworn, deposes and says that he is the applicant ' (Name of individual sighting contract) above named. ' He is the ............... C~ ~..-~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfo~'~r have performed the said work and to m~e and file ~is application; that all statements cont¢ined ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfumed in the m~n~r set forth in the application filed therewith. Swum to before me this ....... · ~. ~ ......... day o~ ..... ~ ........... 19 .~S .... County NOTARY PUBLIC, State o~ NOw York '~'< 5 ~; ': ......... ~'~ .............. No, 4707878, Suffol~ go:unty ~ (Signature of applicant) lnrm Exp,es March 30,