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Home My WebLink About11982-zSUILD~NG DEPARTM~N~ TOWN H~LL SOUTH'OLD, N~. Rev ~ 6/30~80 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH,E PP, E~ISES COMPLETION OF THE WORK AUTHORIZED) ~ UNTIL ~:ULL Permissioh is hereby granted to:~~ ........... :......c .......... .: ......... :'":""7'Y;::, ........... '~' to .................................... ~.~.T~ ........ ..~ ~.. ~. ~.~ ................. ............. ; ................. ~/~~ ....... ~..~,..5....~.....~. ........ ,.../~ ..... :.~: , ...... ........ at ~remmo~ located ~t ............. ~ ................................ ~.~.~ ........ ~ ......... ,.-..~' ................... ................ : ...................................... ~~~.. ~ .., ................... cra% **~ ~o~ ~o. ~000 so~o~ ~,...~.~ ...... ~ :;~.~. ........ ~o~ ~o.~ ....... pursuant ~o Buil~ln~ In~poctor. Fee ~$ ....... ~ ~..~:. ~,:,... ..... } Buildin in~ector , ~/7 '"9 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved 19 ermit No././. Disapproved a/c ..................................... Application No..//t..~. ~.~. ,~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 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 issued a Building Permit to the applicant. Such permit shall 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 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 Southold, 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 comply with all applicable laws, ordinances, building code, housing c~de/~nd regulations, and to admit anthorized inspectors on premises and in building for necessary inspe~ /fi ...~t.~.. ~.' (Signature of~pp[icant; ~r/name, if~t corporation) , // (Mailing address of applica~lt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ............. .As. ............ · ,. ' DATE: Name of owner of premises ...... .~.-..~.~ .~...~..~. ........ ~t4 . .~,.,, ,:,...~: .~:.ff./~t~,~ ~,~ ....... (as on~t~'~'~affrl[~or la[est cfeedB¥: ~_~_, /////_r~ If applicant is a corporation, signature of duly authorized officer. NOTI-~'~-~]TEL~]~G r)E~-R--Th"~_~j~*~;F 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) Builder's License No. ~ .,~'2~.~. ........ Plumber's License No. ' . .~.~. .......... Electrician's License No ....................... FOLLOWING INSPECTIONS: 1. FOUNDA-FION - TWO REQUIRED FOR PO/JRV~D CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSU[ATION 4. FINAl_ - COFJSTRII("TIQN MUST BE C~)~Lf-TF COR C.O. ALL CONSTRIJCTION S*4ALL MEET THE REO*qRSMFNTS OF THE N.Y. ~ArE CONSTRUCTION & ENrRGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done. /~../.~.. ~.~.~}.C.O..~.~.T~ .~fi~..~..~..Q~..5.. ........ · ......... ....... .¢.. ........... House Number Street County Tax Map No. 1000 Section . / t~...~..... Block ./57. ~.. ........ ~ ....... Lot.. t~. d~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~..~.d. CTL . .~..TO. ~. ..................................................... b. Intended use and occupancy D~.I~.6.-I....~rO.g.~. .... 4....D..~.~...~.~t~ .I~!.~.~....~..TP....~.~ ................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . .~'..'i'. .... Repair' Removal Demolition Other Work f/dO "' (Description) 4. Estimated Cost .................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units... ~ ......... Number of 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 ex/sting structures, if any: Front... ~.~ ......... Rear .. 2. Cf ........ Depth . ~: ............ Height ./. ........ Number of Stories I [ nnens~ons of same structure with alterations or addmons: Front .... I~,.~ / ........ Rear .. 1.3..ff .t ........... Depth ..... (~.O.f. .......... :.. Height ..... [O f .............. Number of Stories... [ .................. 8. Dimensions of entire new construction: Front ...... '~ ...... Rear ..... .~$/ ....... Depth ./~O.~ ........... Height' ~ o ~ Number of Stories . i 9. Size of lot: Front .......~ .............. Rear ...................... Depth ...................... 10. r)ate of Purchase ~ . Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation'., b/O ............................ 13. Will ot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises tq,~.,../.E~. /~. ......... Address ff~d~q..g.0...t.0.T~.~ .OC-t~/¢.. Phone No ................ 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 prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW.YO~ !/ ~ ~ . (N~~i~~~ .......... being duly sworn, deposes and says that he is the applicant above named. ~' ~ He is the ........................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~nd is duly authorized to perfo~ or have perfo~ed the said work and to m~e ~d file this application; that all statements contained h ~is application are true to the best of his knowledge and belief; ~d that the work will be performed in the m~ne~ set forth in the application filed therewith. Sworn to before m~ this , .......... ,19~ * ', .... ~~ .... County ~ ~RED W. KAELIN, J~, .. ,.~ x ' ~tate of New YotW Residing in Suffolk,County ........................ No. 52.7~353~5 ' ~ ~mls~lon ~x~re~ Berth ~0, 10~/ ant)