The URL can be used to link to this page

Home My WebLink About12730-z FO~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARThiENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CrHI~R~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPI~,~,I OF THE WORK AUTHORIZED) 12~/3,~) Z Dote ....~.~~...:~ ................. ,' ,,.~.~ Permission is hereby grante to: ~ . .............. at premises I~ated at ...~.~.~.~....~..~. ............ ~ ........ ~~.~ ............ County Tax Map No. 1000 Section .... .)....0..../. .......... Block ....... ~ ..........Lot No....~....~.....'~... ........ Building Inspector. Fee $...),...~.. :..~ ..... Rev. 6130/80 approved by the TOWN OF SOUTHOLD~ OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 ,. ~-!~. ~?~-,;DISCOUNT ~ ~,. ~ n~/n TUUH OWN HOM E ~ATELLITE 'IV SY ' .-. ~gLUDING MOVIES, SPORTS,~'~. CONCERTS, NEWS NE~ORK FEEDS CABLE' HOOKUP. Mon to*Sat~, lOto6F A?T'TC'. 3 AS NOTE~ DATE: 'i).~_~_~3.--B.P' :~ -)~ ~% -- NOTIFV'RUILOING DEPARTMENT AT ~4r~o 9 AM TO 4 P~ FO~ T~E ~OLI ~-klr' b'cpECTIONS: 1, FQLp''~4-'ION ' TWO REOUIRED F~ p..' ,~q-~ CONCRETE R~I 1~.~ - [-r~A~lblG ?~ pLUMBiNG B~ r'-~'~,*--F FF~ C,O ALI r,~ m- .... ¢ FIQN SHALl MEE~ qT~.~ C~NqT~UCTION & ENERGY h!~T RESPONSIBLE FOR DESIGN O~ CONSTRUCTION ERRORS. FIELD INSPECTION FOUNDATION FOUNDATION ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY ~ODE (1st) FINAL COMMENTS (2nd) ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined. IQ.~ .~...q.., 19~.~. Approved ..}0..O.q .~D~...~....~.., 19~. Permit No.}. ~..~.~.~::.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . .O. C~.... ~..5./.. INSTRUCTIONS a. TI, is 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 code, and regulation?, and to admit authorized inspectors on premises and in building for necessary inspections. (Sign'a'ture of applicant, or name, if a corporation) . (Mailing address of applica~) State whether applicant is owner, lessee,_agen~t architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~. ~..:~~ ............................................... (as on the tax roli 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 ...................... Location of land on which proposed work will be done .................................................. · ..¢. ............. ....................................... House Number Street Hamlet County Tax Map No. I000 Section .... l.~.. ]. ....... Block ...... ~ ......... Lot ..... ].~..-~. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Na~ne) 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 ~~t~ . .~..~ .................. 3. Natur~ c(fwork (check which applicable): New Building .......... Addition .......... Altera,~on.. ......... Repair~ .............. Removal .............. Demolition .............. Other Work...>.~ .......... (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ............... If garage, number of cars ..... i ................................................................... 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 ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. r)epth .................... 1.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... : ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... : .................. Name of Former Owner ............................. 1 I. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .............. ^ ............ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~ ~ .~r~-Address ................... Phone No..~/,:3...q..--.O~..q ~.c~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, an& 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. ......~,,,~-. ~,~ ~~'~ ':'nin~ ...... being duly sworn, deposes and says that he is the applicant above named. ~ ~' -' ' i / (Contractor agent corporate officer, etc.) of satd owner or owners, and is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owtedge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this .......... ~..~..~ay of... Nota~ Public ..... : · ~ .... ~~ounty w ~0~ V~g~. St~to 0.~ ~ ~or~ (Signature of apphcant) No. 52-8125850, Suffol~ ~0~/ ~ T*rm Ex~ir~s March 30, 1~