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Home My WebLink About11853-zPermission is hereby granted to: BUILDING DEPARTM~Ni TOWN HALL SOUTH'OLD, N~ Y. BUILDING P, ERMIT~ (THIS PERMIT MUST BE KEPT ON ~H,~,PREMISJ~S UNTIL,~ULL COMPLETION OF THE WORK AUTHORIZED) D~e ,...: . ...... Z~. ....... , I~...Z~ o..,~. :.B~ ~...~..~..~ County Tax Map No. 1000 Section .,;.., pursuant ~o application dated BUilding I~spector. Lot No. i .0.(;~.../.. ........ ~ond 3pproved by the mpector Rev. 6130/80 FIEL~ iN~FECTION 1. FOUNDATION (1st COMMENTS FOUNDATION (2nd 2. ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS '-.,,, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N.Y. 11971 Examine~.e..?. --, 19¢'~2,¢;:¢ TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT Application No.//d~.~..~.i ..... Date .................. 1 INSTRUCTIONS a. Tiffs 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. Plot 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 laybut of property must be drawn on the diagram which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such peru sball 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 Occupan shall have been granted by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for th~ issuance cfa Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, lbr the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors ou premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) /~. ~ ~.~.../.~.~.. ~/~~..~.,.././~.~/. (Mailing address ofapplica~fit) - ' ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ..... .~ ~./-/7"7.~.~..c. 7. ¢/~. Name of owner of prcnlises q.,~,, c?~ ,-,-~ /r.,t (as on the 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 .......................... Plumber's License No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land oll which proposed work will be done. ~. ¢.~./;2.~..~. ~. ?./.-/.~.../~p.~..7..~.~.o.~../.~./.~.,. ........... ...... O.. ./77.~. /. .r/.. . .I.~.17 ..... ~'.¢. .o.F. ?. o. .~.o. . .,. ff.:F:.//¢ 7f ~,'~1/5 .............................................. House Number Street Hamlet ....... S/...c,. .... B,ock ..... ..7. .......... ............. County Tax Map No. 1000 Section Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy PO/)/2/4'p2' ,..¢/./I°/'V-t)F3- ~ l-'d~,~7" ,.e//o.~ b Intended use and occupan y. :, ,: ".':' 3. Nature of work (check wbict, applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal~!~O ............ Demolition ........... ~ (,~- -- ~,- ,w Other W°rk 'P'-t~'~/X~i' 'i' 'escr on. ' Estimated Cost .................................. Fee ..................... ¢ ........... (to be paid on filing this application) ;. If dwelling, number of dwelling nnits .............. Nmnber of dwelling units on each floor ................ If garfige, number of cars .... : .................................................................... i. If business, commercial or mixed occupancy, specify hature and extent of each type of use ,./ff6'4'/~.¥/~.$ ......... ~. Dimensions of existing structures, il'any: Fron~ ..... .' ......... Rear .............. Depth ............... Height ............... Nu!nber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... '... Height ...................... Number of Stories ...................... I. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ), Size of lot: Front .............. ',.. ......... Rear ...................... Depth ). Date 6f Purchase .......... i ................... Name of Former Owner ............................. I. Zone or use district in which premises are situated ................................... :'. ................. 2. Does proposed construction violate any zoning law, ordinance or regulation: ...... /~/..~ ....................... t. Will lot be regradcd ........ ! .................... Will excess fill be removed from premises: Yes No ~..Name of Owner of premises .ff__rPb.l~ 3..I~.(T/.~. ....... Address ~.r+.. UY .~!3...9qq?.~0.H2 . Phone No.?'.~.5.~: ./.$.o.o. ...... Nalne of Architect .......................... ... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existi~g or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. rATE OF NEW)t .R K/ (Nanie of indMdual sig ~ing contract) ~ove named. being drily sworn, deposes and says that he is the.applicant e is the ..................... '.. ~ ..................................................... , ........... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is dqly authorized to perform or have performed the said work and to make and file this )plication; tJmt all statements con!ained in this application are trne to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me thi§.~/J ....... ...... .... 19... oral5t Public~ .~:J/'~'2~. · · .~... ,c'~...,-~...~..,.~.".'. Count~, ' ' -- '~'JUDITH T. TERRY o, ................ . [rio. 52-0344963 Suffolk County..2, ,, (Signature of applicant) , (X)mmisslon Expires March 30, 19,q