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Home My WebLink About14381-Z FOB. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) No 1438t Z Permission is hereby granted to: ~ .l.~....~.;,~'..~....~.....~~ ~..~~~...~C~ ~ / , ~ ......... ....... o, pram,,, ,~o,~ ~ ~.~..~~_.~,...../...~...~.~....~..~~ · ~,.. ~.~~....~.~. /' ~ _. .......... , .... ~ ..... ~..-.~ ........................................................................................ ~ T~x Mop No. J000 ~ctio~ ..L.L..~ ........ m~k ...~. ............ ~ No ..... ~..~..~. .... Building Inspector. Rev. 6~30/80 Examined .~.,.-~....~.~... Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19 ., 19~-~-Permit No. ]..~.~. ~./( ~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Tiffs 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 tiffs 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 co~le, housin~ode, and regulations, and to admit authorized inspectors on premises andin building for necessary insp~/.y~,~.._. ~ ~ iO£¢(Signature of Op~plicant, or name, if a corporation) t',o. ............. ~'¢ ~ ~v* / ~t~i~i~i ;dd;e's} ;} applicant) State , whether applicant is owner lessee, agent, architect, engine~, general contractor, electrician, plumber or builder. Name of owner of premises ................... ~...~ . .~.~... ................................ (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposed workwill be done .... ~.I~....,~..,...r...~...' ..~.~ ....... House Number Street Hamlet County Tax Map No. 1000 Section .... /(.7 .......... Block ..... .~. .......... Lot ..... /..~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupa~ f~re~i,s~.~ and intended use and occupancy of proposed construction: a'Existinguseand°ccupancy~/'' '~''~''~'1'_4::} -0 ~~~. ....... ~ ......... b. Intended use and occupancy ..~'~.~....Z.~...I'.~.'..[..~.T.~.~~"~,[I.~ "~O ~S~.~ "· ................. 3. Nature of work (check which appncable): New Building ..... ' ..... Add~,on .......... Alteration .......... Repair .............. Removal .............. Demolition .. ~ ......... Other Work ............... .~ .~....~.. ~?/~ (Description) 4. EstimatedCost.. .~.l...~. ........................... Fee ........... ~..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 ................................................... f -- 'Ac' ~ ......... ',' · 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~..P~,~..,.~... 7. Dnnensmns of existing structures, if any: Front .~.. ,~>. ........ Rear . . j~.o. ......... Depth .~/~.O. ........... Height ............... Number of Stories .~ ..................................................... Dimensions of same structure with alterations or additions: Front ...~Q../ ........... Rear .3.O.: ............. Depth . ~ l O f ................. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name. ofForgler Ow~ ............................. 11. Zone or use district in which premises are situated..~.. ~.. ~.~:: ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises [0. ~?.'?.~, .~.$.~?.~.~: .?~.~.. Address ~.. ~,.o.~. r..~.o.~ .... Phone No ................ Name of Architect },J.~ .~..&?....~..S~ .~'.( .'~..~ ........ Address~.:~.E?. 7%..~..~. ..... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. APPROVED AS NOTED NOTIFY BU!LDING DEPARTI~,~-r ~ ~ 765-1802 9 AM TO 4 P~J ~F,,~ ~., FOLLOW N~ )NSPECT~O~js: ~ FOUNDAT~O~ 'tWO ~EOU ., ' ''- STATE OF NEWYORK, o o COUNTY ...... 3.0 .....n,~'~ ~'~ -~~'.~'.'' ~-.~. ~ .~~ ............. being duly sworn, deposes ~d says that he is the applicant (Name of individual si~ing contract) above named. He is the... ~/~ .~~L~~-. ~. '~ ......... of said owner or owne~, ~d is duly authomed to perfo~ or have peffo~ed the said work and to m~e ~d file ~s application; that all statements cont~ed ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth ~ the application filed therewith. Sworn to before me th~s ~ · .......... /~.~ ...... day of.~~ ....... , 19~.~ ............... ~ 7 (Signature of app~c~t)