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Home My WebLink About11679-z N~ 1~679 z Perrflission is hereby granted to: BUILDING DE~ARTMEI~T f ToWN HALL SOUTHOLD, j4~ y. BUILDING pERMIT (TH~S PERMIT MUST BE KEPT ON~THE ~t~!$[~ U~T~[. COMPLETION OF THE WORK AUTHORIZED) : t/ ~ ~o. ,, ~o ............................................................. ~. ,-** ...... ~ ............ , ........ '....~ ........ , ~ ........ .. ......... ..... t";' ......... ** ............................. ....................................... ......... 'i?"?''''. ' '" ....................................... County Ta~ Map No. 1000 Section ........... pursuant to apphcotlon dated ............................ .~..*.~.~ ..... · ..... , and ~pproved by the Building Ir~spector. FIELD I~SPE~TION · FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY GODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~; .c. 19 ¢(~/' ~-u Approved /~(Z~;~.. 'f:'R .., l~'/(Permit No. /.g.'.,..~..': / (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. r't.. J'r ......... Date ..~¢,' : 'c,> 19 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin: 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applJ c0fion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, ~e Building Inspector will issue a Building Permit to the applicant. Such penni shal~ be kept on the premises av~lable for inspection throughout the work. e. No building shall be occupied or used ~n whole or in part for any purpose whatever until a Certificate of Occupanc~ shaR have been granted by the BuQding Inspector. ~PLICATION IS HEREBY MADE to the Building Department lbr the issuance of a Building Permit pursuant to tb Building Zone Ordinance of the Town of Sou~old, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for thc construction of buildings, additions or alterations, or for removal or demolition, as herein described l'he applicant agrees to comply with all applicable laws, ordnances, building code, housing code, and regulations, ~d t, admit authorized inspectors on premises and in build~gs for necessa~ inspections. (Signature. of apphcant,, or name,. ~f?'corporaB0n) (Mailing address of a0plicant), ~: whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber 6r bu[lde~ _ ~e of owner of premises ........ ,..~./.( .(: ....... i... :( ........................................... (as on the t~x roll or latest deed) , vpl~c:mt is a corporation, signature of duly authorized officer. (Name and title of' corporate officer) Builder's License No .......................... l'hunber's License No ......................... Electrician's License No ........................ Other Trade's License No ..................... '. Location of hind on which proposed work will be done ...... ' ....... }..' .....'. 'd. '.; .2 ............ /..". ;*f ./'... tJouse Number Street Hamlet ,/' County Tax Map No. 1000 Section . ...., ............. Block .................. Lot / 5mbdivision .................................... Filed Map No ............... Lot ............... (Name) 51dI~ existing use and occupancy of premises anc~ intended use and occupancy of proposed construction: Existing use and occupancy ..... i .............. '. ............ ' ................................... b. intended use and occupancy .... .; .'~.:..: ........ ':.. '.' ...... i' .................................... 3. Nature of work (check which a Repair '. .......... 4. Estimated Cost .... /t ~ ,q 5. If dwelling, number of dwelling Units.. If garage number of cars 6. If business, commercial or mixed occupa~ 7. Dimensious ' ' ' ' of existing structure~, If any: H.~ight i ............... Number of St( Dumensions of same structure with alterat Depth ' Hei~lli 8. Di~. ensions of entire new constr~etion: F Height ........ ,,. ...... Numl~e~ of St .9, Size of tot. Front 10., Date o.f Purchase ..... [.~.' 11,' Zone or use district in which prernl*~'s ar~ l~i': Does proposed eonstmcti0n Violate any 13, Wtlllotberegraded 14. Name of Owner of p~ermses , , Name of Architect , Name of Contractor .. Locate clearly and distinctly' ~11 [bUfldfflg property lines. Give street and block interior or c0rn0r lot, STATE OF NEW YORK, ' ' .~ - country oF . ...i.i. .... (Name of individual signipg contI~ above named. He is the ...................... of said owner or owners, and is duli authorit application; that all statements contained in work will be performed in ~the manner set fortl Sworn to before me this .......... · ..q~.~. ....... dayof~ ....~.. I [.fl Oual New Building .......... Addition .......... Alteration ...... ...... Denaolifion .............. Other Work ........... (Descriptior (to be paid on filing this applJca!i~' . ....... Number of dwelling units on each floor ......... cy, specify nature and extent of each type of use ................. Front ............... Rear .............. Depth ........... ~ries .................................................. .ons or additions: Front ................ Rear ............. ....................... Number of Stories ................. :ont ............... Rear ............... Depth ........... ~ries ' R '~' pth ·.. ear .................. - ...... De .... , .............. .., ..... j.. ................................" situated....~ .. . . ming law, ordinance or regulation: ......................... Will excess,fill be removed from premises: Yes (.0 A .0,... Address..!i {.~.~1 ~;~,~0/< {,~i )%~. Phone No. Z.c/'~.';/..~...-. ......... Address ................ q. Phone No ....... .... ~.u%O.. Address . .,l .h ~:~,t .¥./4 ~c~c, ~1. Phone No. ,/.c~,¢q :~ ..... PLOT DIAGRAM whether existing or proposed, arid, indicate all set-back .d~.finsions description according to deed; and show street names and indicate Wheth, ............ being duly sworn, deposes and says that ho is the appli,:av ct) 'ontractor, agent, corporate officer, etc.) ed to perform or have performed the said work and to make and file fly ds application are true to ~ best of his knowledge and belief; and that th in the application filed therewith. 0 0 h4 ILL4OL~,.i ~%b,