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Home My WebLink About11650-z ' FOItH NO. TOWN 0~'$0~[~ BUILDING DEpARTME~. T TOWN SouTHOLD, BUILDING (THIS PERMIT MUST BE' KEPT ON THE PRE~iS~ UNTIL FULL COMpLETIOIq OF THE WORK AUTHORIZED) .... - ,...,;;~ ......................... N~: ~50 z ~ot~ /~..~. Permmsion ~s hereby granted to:~ ~ ~ ,, ~ , / ...~.Z~. .~ ...... ~. to .......... Cour~ty To~ Map No. 1000 Section .... :'"; Block ;i~; ..... ,...~Lot bio .......... pursdant t8 application dated .. ~.~ ......;../. .;..~...,}...., 19 and qpprov~ by the Building I~spector. ~ , , , Budding Ink.tar , Rev. ,6/30/80 F~ E~ D ~INS?ECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY ~,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined~.~..(( ...... , 19 ~..6''/ Application No. ff./'.( .~.~. ...... ..... , .... ~77: ...... '.7 ......... ~ ....... ', / Disapproved APPLICATION FOR BUILDING PERMIT Date ........... INST RUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fcc according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of'this ap cation. c. The work covered by this application may not be commenced before issuance of Building Pen'nit. d. Upon apprc,'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such per:, shall be kept on the premises available for inspection .throughout the work. e. No buildiag shall be occupied or used in whole or in part for any purpose whatever until a Cer~tificate of Occ~.~par shall have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for th~ issuance cfa Building Permit pursuant to Building Zpno Ordinance of the Town 'of Sou:bold, Suffolk County, New York, and other applicable Laws, Ordinance~ Regulations, for the construction of' buildings, additions or alterations, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and i'egulations, ,'md admit autllbrizcd inspectors on premises and in buildings for necessary inspections. 1.. :,.*. :. [Signature of ap~_'cant, or name, if a corporation) (MaiI~ng address of appllicant) ' State whether applicant is owaer, lessee, agent, architect, engineer, general contractor, electrician, plumber or built' ... .... . .............. .................. . ..... · / (as on tile 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 .... ~"Z"/....~... Plumber's Licens~ Nt. / Ehctrician's License No.' ....... et'her Trade's License No ...................... on which proposed work will be done. ,~.~,\~ .~,tY, .~.itg."..~,~-,V?..~ , ,'y~,L., .~t, ,~.V, .~~ . I. Location of land House Number Hamlet County Tax Map No. ~000 Section ...~ .G .~ ........ Block ..... ~.~ ......... Lot..Q~ A ......... Subdivision ..... ~ ....................... Filed Map No ............... Lot ............. (Name) ,.. b Intended use ~d occupancy ...-~ 4 which lieable): ilding .................... Nature ofwork (check ' iapp New Bu Addition ..... Alteration . .. Repair Removal Demolition Other Work ~l~4.h ~..~ Estimated Cost .~.~.'117.O ~ ........ .... : ................. Fee . . . ~'~ ..v'. ......... t. ................. (to be paid on filing this application) $. If dwelling, nt ~ber of dwelh.ng units ............... Number of dwelling units on each floor ........ ...... If garage number of cars If business, commercial or mi:xed occupancy, specify nature and extent of each type of use ................... 7 ' ' ' if any: Front ' Rear Depth · Dtmenmons ofex~sting stnlctures .................................... Heiglit Number et' Stories Dimensions of same structural with alterations or additions: Front Rear Depth , Height Number of Stories ~. Dimensions of entire new construction: Front Rear Depth Heiglit Ntlmbcr of Stories ' 9 Size of lot: Front '· Rear Depth 10. Date 6fPurcliase ......... : .................... Name of Former Owner ....... [I Z usedi i tin hichp ' sit d ...... · one or sir c w remlses are uate ...................... , ........ ":- 12. Does proposed construction Violate any zoning law ordinance or regulation: {3. Will .lot be regraded ....... . · .' .................. Will excess fill be removed from premises: Yes N 14. Name of Owner of premises .................... Address ................... Phone No ............... Name of Architect ' Address Phone No Name of Contractor ........................... Address ................... Phone No ............... i PLOT DIAG RAM ~" Locate clearly ~d distinctly ail et iklings, whether existing or proposed, and. indicate all set-back dimensions fro~ property lines. Gh'e street and blo&k ntuv. ber or description according to deed, and show street names and indicate wheth( ;,~terior or corner lot. 0 COUX~OF.~'.. .S ~rin~Mdua~igning~~~ contract)· '~ .... being t ly sx om, deposes and says that he the applicm~ ~ov. named. ~ (Contr~cto~, agent, corporate officer, etc.) or snid OWner or own'e~, m~d is dub' authorized to pert'omi or have performed tim said work and to m~e and file npplication; that ~11 statements con,tabled in this application arc true to tho bcs~ of his knowledge and belief;and th:t W'ork will be performed in the maun2er set forth b~ the application filed therewitli. ~worn to before me this .......... ar ' otal~ublic,~~~.~ .... : ' ' ' i aunty - .,. .... . .......... "~r,:c'-'; '.': [ . ' ' ~~~:.'/ . / ' I ...... L~. "' 1' ' ' .....:.~,*. ,.'. :'x ..: i.:. ' . ~ ~. · '. -', ,~ ~o¢r,~. ~r~n' ~ ~, ~'~ '. ' ~ . :'. · t C..:,? ...' It~gnatur¢ o~ apphca~t ......... '""~ ............ ' ........ 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