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Home My WebLink About17238-z I~'OB, M NO. It TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, Ne_ BUILDING P£RMIT cmos ~rr Mus'r .~ K~P~ ON T~ ~MtS~S UNTIL FUn_ COMPLETION OF THE WOP, K AUTHORIZED) Permission is hereby gra. n~ed re: ..../...~.....~~~ ....... ~./..,. ............. · ....... ............................................ at premises I~ated at ....~.~ ............ Coun~ Tax Map No. 1000 Section ......... ~ ....... Bilk .............~.. Lot No...~ ................ pursuant to opplication dated ............ ~..~ .......................... , 19.~and approv~ by the Building Inspector. Rev. 6/30/80 Examined ....... Approved . .7/~..... / FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 ...... ,19. ....... 19t¢ cx Permit No ............ Disapproved a/¢ ' . ..... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ......... :.757. ? ....... SEPTIC FORM ................ NOTIFY CALL ....... MAlL TO: )~ ~~ · dJz-¢~ .~'/~'"~ -o~'~ (B ¢_flding Inspector) NOT~ ~ ~ ~PPLICATION FOR BUILDING PER~IT ~1~~4~~ ~~~: Date .................. ,19... ~~~ INSTRUCTIONS a~ ~ion must be completely filled in by ~pewfiter or in ink and submitted to the Building Inspector, witN 3 , sets ~2~c~r~~ee according to schedule. b. ~~~ion of lot and 9[ bulldogs on premises, relationship to adjoining premises or pubic streets or ar~a~l~r~ of layout of property must be drawn on the diagram which is pa~ of t~s appe- cado c~ ~ t~s ~on may not be commenced before issuance of Bu~d~g Permit. dgffi a~v~a~ the Building Inspector will issued a Bulldog Pe~it to the app~cmt. Such pemit shall ~~~inspection throu¢out the work. e. No bulldog shall be occupied or used in whole or in part for aoy purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the Bulldog Inspector. APPLICATION IS HEREBY MADE to the Building Dep~ment for the issuance of a B~/ding Pemit pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d ot~er applicable Laws, Ord~ces or Regulations, for the const~ction of bugd~gs, additions or alterations, or For )emoval or demolition as here~ descdbed. The applicant agrees to comply with all applicable aws, ordinances, bufld~g code, housing code, and regulations, and to admit authorized ~spectom on premises and ~ bulldog for necess~inspe~ions. __ ~ -- L' "" ': ........ : ............. (Si~qgture ot apphcant, or ~, if a corporanon) / (Mailing address of applic~t) State whether applicant is owner, lessee, agent, ~chitect, engineer, ,general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant ~s 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 which proposed work ,rill be done. ~ ./~../~t2/t:/~/~-~2/~,O ,~>~/,, ~.~~ 1. House Number., Street Hamlet " County Tax Map No. 1000 Section ............ ' Block Lot. Subdivision. ~e~¢~ ................. Eiled Map No. (Name) ~,, .............. Lot ............ 2. Slate exisjing tts~ and occupancy of premises and in tended use and occupancy of proposed construction: b I · ntended Use and occupancy ~..~ 3. NanJre of work (check wbic~ applicable): New Building , Repa/r .............. Removei .............. Dc 4. Estimate'd Cost 5. If dwelling, number of dwelling uniis . ../, , , Ifgara.e. number of cars .~F2. .... i ................. 6. If business, commercial or mixed o0cupancy, specify natur ' 7. m~enmons of existing structures, it' any: Front... Height ............... Numberlof Stories . Dimensions of same structure with ,alterations or additions: 8. si n ofenie wc nstru t n ...... Height ............... Number bf Stories ......... 9 Size of lot: Front ' Rear 10. Date of Purchase .............. [ ............... Na 1 I. Zone or use district in which premisfis are situated ....... 12. Does proposed Construction violate !ny zoning law, ordinan 13. Will lot be regraded .... .(2.d).... 14, ' .......... Name of Owner of premises ..~..< . _ . ~.~J~.~_~.~ .~, ·.. Addrl Name or Architect ..... ........ Addrl Name of Contractor ....... !. · · .......... Addn 15.Is th~s, property located'iwithln.,.~O0 .flee · If. yes, .Southold Town Tr[ustees Permit PLOT DIA( Locate clearly and distinctly all buildings, whether existin property lines. Give street and block numSer or description accc i)qterior ....... 'lot. ......... Addition .. ·.;.?~.. rati9 ......... ............. .... ' (Description) (to be paid on filing this application) qumber of dwelling units on each floor .~; .......... d tel t type fus .~ ........ an exten eacl o e .......... ...... Front ................. Rear ................ ......... Number of Stories ...................... · · l excess fill be r~~ 3 No ss .......... ~.~..~ .~ ..... ss Phone N~ ~ ' ' ~e required. or proposed, .~_~~t~rrjtlrrg$ from ,in deed, l, ii STATE OF NEW YORK, COUNTY OF S.S .............................................. bein (Name of individual signing contrhc}) above named. Il i th ' e S e .............. ' ontractor, agent, COt of said Owner or owners, and is duly authori~.ed to pe,rform or hart application; that all state~nents contained in tiffs application are true Work wili be performed in the manner set fortlI in the application filet Sworn to before me this ............. /. : ...... day of.. .......... ' ...... County 31RY IPUaUC, Stm d New YodL No. 47078711 Suffolk mm, F. xpl~ M~ ~ .~0 ' ..co ~ .wi-~ ~ duly sworn, deposes ~d says ,rate officer, etc.) performed tbe said work and to make and file this to the best of his knowledge and belief; and that the therewith. ~A. · (2 .... (Signaffure of applicant)