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Home My WebLink About18141-z roam xo. s TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N ° ~ ~ ~ Z Date ...(..ll„ `~....~.6.........., 19..G~.. Permission is hereby granted t/o: ...Gn r4r~'/......... ..;v........ ~ to ../~Gl~'~ ~....a........................................................... at premises located at .......G./.~,.../..LI.~~~ld~..Gl(~'!~ ~.rZ!!/! leFr1..{!~.. County Tox Map No. 1000 Section .......fit Block ......~jt............ Lot No...~Y.!...'~- c pursuant to application dated .~a!~%9R~ ..............`.r!........, 19~.~ond approved by the Building/Insrpector. Fee ~.,1'. ~l~Ffi..' C Building Inspector Rev. 6/30/80 D 15 ~ D FORM N0.1 ~ TOWN OF SOUTHOLD ~-1SZ/~ BUILDING DEPARTMENT TOWN HALL BLOG.GF~ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined 19 Application No................. . Approved ....'/.[../~j~ .~ii., 19~1.~ermit No. Ll.~. Disapproved a/c . _g-.~__ (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 ?;hall ~ iff6C 'ding Inspector. APP~j~~Ip,~}d~lt MADE to the Building Depaztment for the issuance of a Building Permit pursuant to the Building ZIB&~lltl~n"C~0Tlt6he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations,I`f~e 'i?ition 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 inspections. (Si nature of applicant, or name, if a corporation) (Mailing ~dciress o,f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general ,contractor, eleCt~iGian, plumber or builder. - . .....~~m,ir~?~ ' ..e~ ..............................:..::...s....:.:°....:................ Name of owner of premises ,.~!v~~~~....~ar5~u:~~......~:,~,..:,`.....:.,.~......~. (as on the tax roll or latest.deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of coor~porateC~officerL) Builder's License No. . l J / ~ / Plumber's License No . . Electrician's License No . . Other Trade's License No . . I . Location of land on which proposed work will be done. .(._:,t~P l~~~.N! . House Number Street Hamlet County Tax Map No. 1000 Section Block Lot ~S....... . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and inte/n/d~e7d use and occupancy of proposed construction: ~ a. Existing use and occupancy ~~~~~/~...~~z'/YJ.C/~ . b. Intended use and occupancy ~4~.~.!~~!!~~...~/ oo, ~ . . . . . . . . . . . . . . . rl ~ ~tt { . 1~'~.. 3. Natpure of work (check whine applicable): New Buildin Demolition .Addition . • .O~}1er o eliAtz1,;,. ; ~ . . Re air gval p' 4. Estimated Cost z' ~ y ~ ®r Fee..l ~Q.-.. . . (to be p don °th19,~p~j~da'titS$) E ~ ¢C' 5, If dwelling, number of dwelling ,`units Number of dwelling units on eac 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 constluction: Front Rear ...............Depth . Hei ht Nunjber of Stories':'...... ' . . . . . 9. Size of lot: Front Rear : ; Depth ~ . 10. Date of Purchase j Name of Former Owner . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning ]aw, ordinance or regulation : . 13. Will lot be regraded ...................Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...I .................Address ...................Phone No............... . Name of Architect .................Address ...................Phone No............... . Name of Contractor ...............Address ...................Phone No............... . PLOT DIAGRAM Locate clearly and distinctly all 1, 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 corner lot. r. ~ p ~ "IMMEDIATELY" l°~•'`~~ ~ ,_._.i iNCLO8RPO0L7QCODB UPON COMPbET1ON BEFORE "WATER" CCUPACY DR USE ~S UNLAWFUL CCCUPA CY O ~~TUCT CE,T~F~CATE USE ~S U LA FUL OCCUPANCY ITNUT CET~F~C~T CF CPANCY STATE OF NEW YORK, S.S COUNTY OF • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................I'',.................................................................. (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannet set forth in the application filed therewith. Sworn to before me this .......,19.e.! • Y Notary Public, da of~ ~ ~ Coun tiFtEN K. DE VOE Stote of New York ~ (Signature of applicant) NOtARY PUOLIC ' • • • . • . • . ~ • . ' No. 47U't$"iN, Suf(uIN Coun Terrn Expires fbSslroli 30,19