The URL can be used to link to this page

Home My WebLink About11890-z FORa~ ~0~ ~ !TOWN OF $OUTHOLD i BUILDING DEPARTMENT: TOWN HALL SOUTHOLD~ N~ Y. BUILDING :P, ERMIT~ (THIS PERMIT MUST BE KEPT ON THE pREMIsEs UNTIL FLILL COMPLETION OF THE WORK AUTHORIZED) N°. 118 9 0 Z Dote Permission, is hereby granted to: -. i : ........ .......... ......... ~o .......... ..~..~..~Z..~-~. .......... ~. ~...~ .: .................................. ........................................ .................................................................................... ~ ......... ~ ........ t,~' *i ........................................ at premises located at ........ ~. .... "' ~"'~'~'"~'~"7 ................................. ................. ;. ............................................................. · .-~ ........... ;..~....~.; ............... i~::,~- .................................. County Tax Mop No. 1000 Section ..~...~..~.. ......... Block ,;.~..'~c:'.. ....... Lot No.(:Z2/.~.,~ pursuant to application dated ..... ,~i,~,...Z.~' .................... i"'"' 19~ and approved by the Building I~spector. Fee $.../..~' ....'~.. ......... ~~"'~"~//'.,~/~,. . :ii , /~'' Bu~Iding Inspector Rev 6~30780 F~E4~kINSPECTION COMMENTS ~' ~ FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N, Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined .~.> ........... ,19 .~. ·c~ Approved.. ~.(/. .......... l~.,7'~eennit No. //. 6.~.? .~.: (Bufldin~ Inspector) APPLICATION FOR BUILDING PERMIT Application No./~, .ff .~...~.. ....... Date ..... ..w...t4..t..'7[ .'..7_:.~...., 19 ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~i._-~= to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avai/able 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to cmnply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. , .. £'..,,.,. !. :'.: ( :,..,? :. ~ ~, ' -2 .~./'~, c t - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,Sgeneral contractor, electrician, plumber or builder. Nan~e of owner of premises ....... .~...o..~..M,....~.-.. ~ ¢ A ~ (5 ........................... (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.....~g~ ............... Plumber's LiCense No ......................... , \ Electrician sLi~nse No ....................... Other Trade's Lice~e No ...................... 1. Location of land on which proposed work will be done.~ (:> Z- ~ House Number Street Hamlet County Tax Map No. 1000 Section .'..~O..~..~.. ~ ....... Block . .O. ~ ........... Lot....(~..[. ~.'..O..o.'.27.. 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 an d occupancy .... .[... ~.~.~),.C...~ . ~ p-.).C::..%.C.I .t-l, dO7.... , ............................... b. Intended use and occupancy .... ,.~..~.~..~.....0,3... J..~'A'-~...~. ~.Cr. ,.~.~ ................................. 3. Nature o, '.,'cc,~ tenet ..... ~,, . ,. .. AddlrSm ........ 2ratio~ .... :, Repair .............. Removal .............. Demolition .............. Other Work. (Descripti~pn) 4. Estimated Cost ~ ~.~.OC.~ Fee ~ .... Z~:..' .Ct?..~.. : (to be paid on filing this application) 5. )'g~elling, number o f dwelling: units ............... Number of dwelling units on each floor ................ l~(ga"mge number of cars ............................ 6. If b~sines~, commereial or mixed occupancy, specify nature and extent of each type of use 7. Di.m.~si/ns\ '/ of existing structures, if any: Front ............... Rear .............. Depth .............. Heigh~ ............... Number of Stories ....................................................... l)im.~h, st~s of same structure With alterations or additions: Front ................. Rear ................. ..,r,%Depm ...x ................... Height ........... . ........... Number of Stories ............ t ......... ( 8. 'J)imensions of e~ire new construction: Front .... .~..~.'. ...... Rear ..... x ;'"."'. ...... Depth /.¢... ,. . . 9. ,~o~lot. Front ...................... Rear ...................... Depth ...... 10. Da~ofPurchase ......... J.~..~...~. ............. Name of Former Owner .L,~.~/... 11. 7~ne~r use district in which pr~mises are situated ...................................... 12. ~O~ t~0P°sed construction violate any zoning law, ordinance or regulation: ................................ 13. Will Iot~e regraded ............................ Will excess fill be removed from premises: Yes No (ameof Owner o remises . .~.o~ 4s ~-,,~E r~ . Address s- g-~e~ tee . Phone No. r p ................. &,. g. ........ .~fi~..o. .... 2 .B. ~r...~. ??. .... amc of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate alt set-back dimensions from property lines. Give street an~eed, and show street names and indicate whether interior or corner lot. STATE OF NF~RK., . ./ S S ~ (Name of individual signing contract) above named. being duly .sworn, deposes and says that he is the applicant He is the ................. d;~.~cx~ .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file.this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this N 1~ P~ublic, ............... unty 4~ : ~ E~oires ~le~h 30, 1 7