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Home My WebLink About11903-z TOWN OF $OOTHOLp ~ BUILDING DEPARTME~i TOWN ~HALL ~ ~ SOUTHO[D, H,. Y. L: BUILDING PE~IT, ~ (THI~ PERMIT MUST BE KERT ON THE pREMISeS uNTIL ~ULL COMCL~ION O~ THE WORK AUTNORIZED) Z Date 'No. ~19o3 Permissiori is hereby granted t~o~_~ ..... ~ ..................... ~.~ ....... .=.~,~....~~z/..~. ........................ at premises located at ........ ~...~/..4'.:~'.'.:~.....:t4.~/~ ........... ......... ;~...... ~~~2.~...~ ....... ~..,...~.~" ............ ~ ........ ........ ~, ....................................... Couhty Tdx ' ' ~r ~ Map No. ,000 Sec,o~_~. ~'.'"~'~':' ,~o~~:"~/";""~L°~ No...~ pursuant to application dated .... ~:~.~... ...... '.,.:...i~L..., l~/and approved by the Buil~Jing I~spectOr. Fee :$ ............ ' Bdllding~ InspectO~ RevL 6/30~80 DATE COMMENTS ADDITIONAL__COMMENTS: FIELD ~NSPECTION 1. FOUNDATION (1 FOUNDATION (2nd 2. ROUGH FRAME & PLUMBING $. INSULATION PER N. STATE ENERGY C,ODE 4. FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 E am,ncd.. . ........ Disapproved a/c.. ...... ~ ...... 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, 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 dia~am which is part of this ap~ cation. c. The work covered by this application may uot 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 pen~ shall be kept on the premises available for inspection throughont the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Oecupan 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 t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the coustruction 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 regntations, and admit authorized inspectors on premises and in- buildings for necessary inspections. (Signature 6f applicant, or narffe, if a corporation) (Mailing address of applicant) State whether applicant is o;vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .......... ;o'li &; iltk'st' ~;id) ....................... If applicant is a corporation, signature of duly authorized officer. · (Name aud title of corporate officer) Plumber's License Ns ......................... EI~ctrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .......... .~...,~...~/fl..~./... .................... House Number Street Hamlet County Tax Map N ¥ Su ivision ....................... -..: ........... Filed ........................ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ............ ~-. ..... ~..: ......................... b. Intended use and occupancy ........ ........................................ 3. Nature of work (check which ~pplicable): New BuLlding .......... Addition .......... A Repair .............. Removal .............. D~:molition ............ Other W, Estimated Cost ............................ e .................... (to be paid on filing ;, If dwelling, number of dwellin~ units ............... Number of dwelling units on each If garage, number of cars ...; .................................................. i, If business, commercial or mixed occupancy, specify fiatnre and extent of each type of use .., h Dimensions of existing structures, if any: Front...; ........... Rear .............. Height ............... Number of Stories ...................................... Dimensions of same structure With alterations or additions: Front ................. Rear Depth ...................... Height ...................... Number of Stories .... ~. Dimensions of entire new cons}ruction: Front ............... Rear ............... De Height ............... Number of Stories ............................... ' ...... L Size of lot: Front ......... ~ · · .'.' ......... Rear ...................... Depth .... ). Date 6fPurchase ......... ; ................... Name of Former Owner ........... I. Zone or use district in which premises are situated ....... ' ............................ L Does proposed construction violate any zoning law, ordinance or regnlation: ............... 1. Will lot be regraded .......... . .................. Will excess fiI1 be removed from prem~ L N~me of Owner of premises~/Z~(~.. [>~. Addressff~/{~Uff, .~l~l~.... Phone Name of Architect ........ i. ............... '.. Address ................... Phone N~e of Contractor ........ .................. Address ................... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set roperty hnes, Give street and block number or description according to deed, and show street name: :terJor or corner lot. )4 teration .......... (Description) this application) th es: Yes No rock dimensions from and indicate whether TA'I E OF U::IE~V(~O ' · * RK,- -- [ S S OUNTY ~. . (Name of ~ndividual s~gning contract) )ove named. els the / L (Contractor, ag/~nt, corporate officer, etc./ said owner or owners, and[is duly a~-ho~zed to~perfoi:m or have performed the said work and to make and file )plication; that all statements contained in this application are true to the best of his knowledge a ~d belief; and that the · ork will be performed in the manner set forth h~ the application filed therewith. ~vom to before me this _ot~w Public ...... ,.~ ....... -o."~.. · ~ ~ -- ~ .o /~/ I - - :'"'?'"m':: .... SUFFOLK CO. HEALTH DEPT. APPROVAL ~TA,TEMENT OF iNTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM tO THE STANDARDS OF THE SUFFOLK CO DEPT OF HEALTH SERVICES APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CONStRUCtION ONLY DATE:. APPROVED. SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL lOC;O 05? i "' OWNERS ADDRESS: DEED: L. TEST HOLE STAMP SEAL