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Home My WebLink About11967-z FOR~& NO. TOY(II OF SOU HOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N~. Y. BUILDING (THIS PEPJ~iT MUST BE KEPT ON THE P~EMISES UNTIL ULL COMPLETION OF THE WOP, K AUTROR. IZED) Permission is hereby granted to: Building Ihspector, Rev.? 6/30/80,, FIELD >NS?'ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved /..~..-7.../...~. .... 1 .~.. Permit No ........... (Building Inspector) APPLICATION FOR BUILDING PERM IT Application No.'~..'~ .~.Z .......... Date. ~ .~..., 19 .~.¥ INSTRUCTIONS a. This application must be completely filled in by typewriter erin ink and submitted 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 tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of thit application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~ be kept on the prenfises 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 Occupancy shall have been granted by the Building Inspector. APPLICATIO.N. IS HEREBY MADE to the Building Department for th9 iseuance of a Buliding Permit pursuant to the Bufidin~ Zone Ordinance of the Town of ~outhold, Suffolk County, New 'York, and other applicable Laws, Ordinances or l~latiom, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant a~rces to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to edmit 'uth°rized inspect°rs °n Premises and in building f°r nece~n .%4,~.<,~ ~ "/%L'_' :iLi .... ~ ..................... (Signature or' applicant, or nav~e, if a corporation) r.. (Mailing address of spplic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ....................................................................... Name of owner of premises . : .~.'..~..~..0....~,. ,....~....6~ ~.'.~..~.'..~..~_.~....~....~...~..~. ..... (as on the tax roil 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 on which proposed work will be done. ~,. ~-C~- t ~.-) ..- .......................... County Tax Map NO. ' 000 Section ..... ~..~ .......... Block ..... ~ ......... Lot ................ .~..~ 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 ..... . .~...C~..~.O...{~Y'L~....']~,,-.~..~..t~..~{~.~. ~ ........................ b. Intended use and occupancy ...... ~.?~, ,~.X O. li~e~'~,,, . ~.~.~ t: ~. ~t~). ,~', . ,~_~,. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat/oJa .......... Repai[ .............. Removal .............. Demolition .............. Other Work .Jr~.V~... !. i (to be paid on fling this application) 5. If dwelling, number of dwelling ~nits ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height: . .............. Number of Stories ........................................................ Dimansions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ...................... ~ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .... c]~.,..2~. ?.S'/.. Nm,ib~ u-r-Stori'~ .-[-~:~. p.~...-~A~.c~.~. .......... .~9...q;~r. ~ .c....C~ ?~.. L~...~_ ...... 9. Size of lot: Front ........... i ........... Re'itt ...................... Depth ................... 10. Date of Purchase ........... . .................. Name of Former Owner ......................... ~... 11. Zone Or use district in which pr~mises are situated ..................................................... 12. Does p~oposed construction rio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i ............. x. .....Will exce.~ fill be removed ~om premises: r Yes No ~14. Name of Owner of premises . .~..e? V.~ .%~?. ~t~.... Address ...%>~..e~.7~.. ~. ~. :q... Phone No.-l{~..~.c/.'.~.-¢.c?. Name 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 all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether inte or or orner lot. STATE OF NE~ORK, ~ ~. COUNTY OIL%.3~.~/,.g,~(~.. ~'~ (Name of individhal signing ~ract) above named. : He is the ..: .......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, md is dul~ authored to perform or have perfo~ed the said work and to m~e and file this application; that ~1 statements cont~ned ~ this application are true to the best o~wledge and belief; and that the work will be' perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ........... ~..~. :...day of:..~.~.., 19~ Nota~ Public,, . .................... ~ County , ~ ~ ~ ~gna~ure o~ a dcam~ NO~RY PUBLIC, 8tale of New York PP Ne, ,52-8125859, Suffolk fo~.. Term Ex,ires March 30, J