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Home My WebLink About14225-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) 14225 Z Permission is hereby granted to: ..... ~~.~...~..~..<~.]..~ ......... ..... ~.~..~/~.~....~: ..................... ..... ~.~._~.~7.~.~...~..~.~ ................. ,o....~~.....~.?...~~...~ ...... ~~....~ ................... .... ~~....~~..~~..~ ...... ~~ .......... at premiss I~at~ at .....~.~....~..'~.~....~ ..................................................... ............................................................................................................ ~~/...~.~/ Z~ ~ .............................................. Building Insp~tor. Rev. 6/;30/80 130.OB" RoAD (N. YS Rte. 25) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL uoOUTHOLD, N,Y. 11971 Examined ~ 19e/ Disapproved a/c .......................... t/~/: ........ (Buildin8 Inspector) APPLICATION FOR BUILDING PERMIT Date 7 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 oh 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 ]~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or F~egulations, 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 :~dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ....... ............... (Mailing address of aptplicant) ~;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ow,mr of premises .... ~ ~..~.~."~ ~c~r2 ~.,../~:~. i .~.....~t~: ...................................... (as on the tax roll or latest deed) It' 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 ...................... Location of land on wbich proposed work will be done .................................................. eoq -' .... ..................... ...... llouse Number Street Hamlet Cotmty Tax Map No. 1000 Section ...... /..O.d ....... Block ..... .O..~'~ ........ Lot...0.O. .5 ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ...'~.t~(~.~...'7..~.. / . ./~.~../-~..~.C~. ,' ? i-~LI..~,~..~.~ ~ 3. Nature of work (check which applicable): New Building .......... Additiqn .......... Alteration ........ Repair .............. Removal .............. Demolition.~R~(-e'.t..o.¢-...t--~. , Other Work .. ;~.......f... ~ /' ' oc) __ ttJes_c_n~pnon ~ 4. Estimated Cost .... -~'. 7 ~ O..O..Q...'7. ............... F~e .~..,.,./..O..O...-77...75...'~../.~..O.'~.O. ~ ..... <' (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 ...................................................................... 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 ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. _14eigh.t ......... Number nf Sro .ri_'eS .............................................. 9. Sizeoflot: Front ...................... Rear ...................... Depth .................... 10. Date of Purchase ............................. Name of Former Owner ........................... 1 1. 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 . h 14. Name of Owner of premiSes'/<'.~/:'-/:' ' t(.¢~..q .r. .... Address ................... Phone $~r:~.~..-.4,~'.~.~... Name of Architect ........................... Address ................... Phone No .............. Name of Contractor .......................... Address ................... Phone No .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) above named. He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fiI~"th application; that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... ~....[~. .... day of ...... ~{,tA~ ......... , 19 ff.~.. . Notary Public, ......... ~ttt[~l~' '~/~'' '~'~''': '°~'''' C°unty[ O[ ~0£' ' ~'fl'* ............ ~' ' '~' ' /' ~i'~n~ ~l, 4~7878, Suff01~ C0u~ ~ ~e~ Ma~ch ~0, 19 ~