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Home My WebLink About11978-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11978 Z Permission is hereby grunted to: / / .......... ,...~: ............ ~..~ ................................... ....... ........... ,o ....~..,.:~:....~ .............................. '/.~..~,.., ....... ,..~.,.Z~....../.....,,...~...~.f.,...~ ~.~-¢ -- ..................................................................~;:~Z- ,.~/,~'"' ......... ,./-: ~z~ ~ ~ ~,~.~ ~ W. at premis~ Iocatod at ......................... ~ .............. ; ............... ,- ............... : ..................... ~"'"7' ......... Counly Tox Mop No. 1000 Section ........................ Block ...~ ......... Lot No. ~ .... pursuant to application dated ........................................................ , Ig...~...Y.'~=nd approved by the Building Inspector. Fee ........................ Bull61ng Inspector Rev. 6/30/80 FIE~D I~SPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Bu~ling-lnspector) APPLICATION FOR BUILDING PERMIT ~STRUCTIO~S a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot phm showing location of lot and of bu~ on premises, relationship to adjo'ming premi,es or public streets or areas, and giving a detailed description of layout of property mint be drown on the di~gg~n which is part of this appli- cation. c. The work covered by this application may not he commenced before issuance of Bs~idin~ Pm'mit. d. Upon approval of this application, the Building Lqspector will iesu~d a Building Permit to the applicant. Such permit shall he kept on the premises available for impection throughout the work. e.- No building shall be occupied or u~d 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 isemmca of a Building P~Tait pursuant to the Buildins Zon~ Ordinance of the Town of Southokl, Suffolk County, N~w York, md other applicabk Laws, Ordinances or R~latiom, for the construction of bulidin~, additiom or alt~r~lom, or for r~moval or demolition, ~s ~ descrlhed. The .appticant ~ to comply with all applicable law~, ordinances, bullding, cqde.s hoUail~g code, and r~,ulatiol~, and to ~m,t.~tho~ in.to, on p~,, and in ~in~ for ~,ce.,~ m.s.~S'~.// ~Z'-/'/ /'~,,~/ // ...... .'~..~....~. :.~ ........ (S~nature~,qf applicant, or na~i, if -. col~oration)/.-) _ (as on the tax roll or latest ~1) 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 ...................... Location of land on which propgl~ed work will be (~one .............................. , .................... · .......... ...... ................. : House Number Street Hamlet County Tax Map No. 1000 Seat/on . ..... Bl~Ck ..... "~ Lot. /'O Subdivision ..................................... Filed Map No. ·,-. ........... Lot ............... a. Existing use and c~cupancy 3. Nature 'of work (check which applicable): New Building .......... Addition ....... ~.. Alteratd~n_____ ~..., ......... Repair,. ............. RemoVal .............. Demolition .............. Other Work .(-~../el .t~'.~. J~.. 4. Estimated Cost ...... ~. . ..................... Fee ./7 ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ..... / ........ Number of dwelling units on each floor.. If garage, number of cars ..... .,e.z ........................................................ ' ~" ......... ii'"... 6. If business, commercial or mixed occupancy, specify ~ttur9 and extent of each tvp~ of use .............. .fi ..... 7. Dimensions of existing structure~, if any. Front ~.. Rear '~.,~. Depth Height ,, .,zf,~..' ........ Number of Stories ........ / ........................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .............. ...,.? ............................ ] .......... 9. Size of lot: Front'~'z,r'z,' >;,'fi"~'7~'~ .. . Rear .... ~..~ ............ DCl~,h .... /..~.~.' ..... ' ...... 10. Date of Purchase ii Z~;/.ef~. ~"d'.'. iii:i'.i ....... Name of Former Owner . ~C~/~/~-~... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viol-at0 any zoning law, ordinance or regulation: .... /~.~. ..................... 13. Will lot be regraded ....... ,ff~_.~ .............. Will e>cee, m,gill,he removed from premises: Y~es. 14, Name of Owner of premises f~.~ff~..{--.t.A...~..~r~.. Addres .s~.~/..~(~-~e~ff~,,~.,,~.. Phone No...~..~.':~. ~./~... Name of Architect .......... , ................. Address . ?'.~. ~..~.~..~'.~.~.~. ( ~(.. Phone No ............ Name of Contractor ........................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 interior or corner lot. STATE OF NE~F~)DRK, ,~ ~ S COUNTY~jF~. deposes and says th~ae is the applicant ..... ~~,: :'; ~ ............. being duly sworn, '(Name o~ inaiviauat signing contract) above named. is the ............. o.~,~,~.. (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-lt~s-knowledge and belief; and that the work will be performed in the manna set forth in the application filed Sworn to before me this Notar/~Public, .......... ~ ..... : ~TPff:~'~. County /~ '~ ' ,,~ . ~i0~/IV ~UltI_~C,~ State'of New ¥or~, { (Signature of applicant) Ne, 52.8125850, Suffolk Cok#'~tl/ X ' ' Tirm Expires March 30, 19~./ ,