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Home My WebLink About11464-Z FOBM 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 THE WORK AUTHORIZED) N? 11464 Z Permission is hereby granted to: ..... ............... County Tax Map No. 1000 Section ..../.~< ,~... ...... Block ....~...~... ........ Lot No. '~'~'"7' ....... pursuant to application dated ..~.g.,,~'~'g--,~ff--.~-~,. ................ 19 ........ , and approved by the Building Inspector. Building Inspector Rev. 6/30/80 MAP OF LAND SU ~VE,¥~O FO~Z G. ~ Do~.~5 AT "A £5 HA M Olvl OQUE" TOWN OF 50UTI4OL, D,N.~ SCALE: BO'= I" ~ = .rlnonumcn'J': Exa,nined ~/~..../' 9' ........ ,19 Approved..-~..../.~. ..... FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19~. ('. Permit No..//..~..6r..~..? Application No.././.~.~..¢. ...... Disapproved a/c ....... '..-...~-'~.. ........................ - (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................ 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIc, t plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which ispart of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc :at of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such peru shall be kept on the premises ava~able for inspection throughont the work. e. No building shall be occupied or used in whole or in pm for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS ItEREBY MADE to the Building Department for the issuance of a Building Pemit pursuant to t Building Zone Ordinance of thc Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constructiou of buildings, additions or alterations, or for removal or demolition, ~ herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and mgulationz, ~d admit authorized inspectors on premises and in buildings for necessa~ inspections. .......... (Signature of applicant, or name, if a corporation) .... ........ ~ (Mailing address of applicant) - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electficmn, plumber or build N m ~ of owner of premises ........................................................................ (as on the tax roll or latest deed) If applicant is a co~oration, signature of duly anthorized officer. (Name and title of corporate officer) Builder's License No .......................... lqulnber's Licens2 No ......................... Electrician's License No ....................... Other Trade's License No ..... .~....~..]. ......... Location of land on which proposed work xvilt be done ................................................ ....... ~? .......................... ,.'....~. :/..,~."~..~..97',z. .. ..... House Number Street Hamlet County Tax Map No. 1000 Section I 2~ ,5- Block ~"~ Lot . .O..~'~.~... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy .................................................................. Repair .............. ,:;ac,'al .............. ;. :::ciir~on .............. Other Work Es ...... ted Cost ..... 1 ' ' · t ......................... (to be paid on tiling titis application) ;. If dwelling, number of dwelling units ...... ./ ........ Number of dwelling units on each floor .... L ........... If garage, number of cars ....... /./, .~,~.~-.. .......................... i. If b~,sines$, commercial or mixed occupancy, specify ~0tu.re and extent of each type of ule ..... ~. Dimensi~nsofexistingstnctures if any' Front '~. Rear ,R--'?" '~,' '-,- ''"¢'e;~- ...... He,ght /~.*.....~e{ ..... Nvmber of Stones... /.. . . Dimensions of saj. ne structure with alterations or additions- Froni' ' ' ~.'~ .......... Rear J ~ .. Depth ..... .3.(.. ....... . ..... Height .... 5'....,,we:n~.. ............ Number of Stories .... ./ .......... I. Dimensions of entire new construction: Front ....... ~ .O ..... Rear .... ~..~. ....... Depth ...~...-~--. Height .. ~..~... Number of Stories . ./. ' ....... 1. Size oflot: Front ~ 5'~ ' ' Rear .f.~J'7. Depth /.5(0.. ). Date 6fPurchase ............................. Name of Former Owner Zone or use district in which premises are situated ........................ iiiiiiiiii Does proposed construction violate any zoning law, ordinance or regulation: ............ ~.~.' ................ .?. ill 1o t be ,r,e, grad ed ....... t/_.q~.: ............. Will excess fill be removed from premises: Yes No Name of Arc fitect Addre~ ............. fi' ................... .Nam~ of Contractor .../5.0.'~.~ ~..~ Address ./P7~ Z'~JT~ ,-4 ... Phone No ................ Phone No PLOT DIAGRAM Locate clearly and distinctly all buiklings, whether existing or proposed, and. indicate alt set-back dimensmns from '<~ert7 lines. Give street and block number or description according to deed, and show street names and indicate whether , ..1~o: or corner lot. FATE OF N] : '~ UNrry (Nanie o .ovp named. ........ '~'~' '~ ~ , being duly sworn, deposes an~! says that he is tile applicant adividual ~ig'ning contract) : is the .................... ~ .... ~. . , sa~d owner or owners, alld is duly authonz~"~'d-to perform or bare performed th,: said work and to maXe and file Ellis plication; ~at all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth N the application filed tl~erewith. ,'om to before me this .... ~ ...... ¢~ .... dayof .....~~ 19.~ ..... Co,,nt __ .... : ........... .... ~ ~ (Sigw~ure apphcant)