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Home My WebLink About10277-z FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Ex .ined ...... Approved ..... [>Z],.. ·: . · . t., 19 ...;Pennit J'~o ............ Disapproved a/c ,~ .................................... .-¥. -,~,, ......................................... '~ ' / ;~ .';}:~'/Z, .....'~"~1 :' ~ 'Z'" 'A~ }/ ................ :../... ,/.:?.~A !.'1.. (Building Inspect%r) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No./.(? '?:'./.'./. ...... 0 Date ...... ............. 19... a. This application must be completely filled in by typewriteraccorr ~;~ in ink and submitted in triplicate to the Building,~_ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee a d' g to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and g~ving 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 issue 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 lied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been Inspector. APPLICATION IS HEREBY to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the of Southold, Suffolk County, New¥ork, and other applicable Laws, Ordinances or Regulations, for the construction additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on t in buildings for necessary inspections. (Signature of applicant, or name, if a corporation)' ~rT~ ........ i .............. (Mailing address of applicant) \ State applicant is owner architect, engineer, general cent ct~r, lan, plumber or builder. Name of owner o f premises.. ~,,. ..... . ... ~t,~ ."~ .~.~~ ' ['/ ~;;' ;~e~x'~o'li ;; i~t;~t'd~) ......................... If applicant is a corporation, signatur'e-[f duly authori ed o f~r. ~ Builder's License No .......... ; ............ ~ - Plumber's License No ....................... ~. Electrician's License No ............. ~ ?..~..~.. Other Trade's License No ...................... : ~ 1. Locatio~y/~;nd..Tn which proposed work will be d0~n~.e~f i · - · .(. ..... .~..~ .................... House Number Street H_jtl,fflet County Tax Map No. 1000 Section .... -.,::'. ......... Block .... :...~......./~/~ .... ~..:':. .......... Subdivision ................. ~", ................... Filed Map N'~o... '~':~ . ./.../f"-'-~t .... 'xi'~i'./ .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of propose [ con~u,~: /~/ a. Existi!lg use and occupancy ........................... /. .... ....... i ": .... ~ ............... b. Intended use and occupancy .......................... ' ........ i'., ................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ..~.. ~., .,.....fi... (Description) 4. Estimated Cost .... .:..5~ :( .. ~. ......................... Fee . ./.'~f. .....'7 ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 ........................................................ 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 ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises 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 ,.. '~ ..... , ..... ~.g Address ....... ' ~'" Phone No. ~ ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor i ......................... :'. 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 interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................... <~. ............... . .................................................... (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 his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ~. ~ .., .... ......... day of ..... . fC':'?N: .......... 19 Notary ~iblic, . ................................ County laJ~ngTrg c. coN'S6',/ ....................... '"'; .................. rUB[itC, State of Now York (Signature of applicant) County I'1o. 52-5792800 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10277 Z Permission is hereby granted to: ...x.L.~..(?.:~. .......... [ .......... LL .~.'.. ~. f.~..!:!..~., i~!..~C ..'t~ .... at premises located at , ~....~ ~. ........ ?.~.~,~..~ ................................................................... ...................................................................... ,~.J.~.~ .T~.~...J..:'~:.d.f...(:4 ....... .bL.:J(. ....................................... ) pursuant to application dated ............................... :xj.t.J.~.~,....~....., 1~..~....., and approved by the Building Inspector. Building Inspector TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TO~VN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 November 12, 1980 John L. Hussnatter, Jr. RR1 - Box 169C Mattituck, New York 11952 Dear Sir: ~ This is to notify you that Building Permit No. 1~277Z issued June 26.~ 1979 to Build A/G pool will expire-on December 2b,' 198~ If more time is required to complete the Job and obtain a Certificate of Occupancy, you may apply, bY letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly y~ours, GEORGE H, FISHER Sr. Building Inspector THE NEW YORK BOARD OF FIR,., UNDERWRITERS ,,~{~,, BUREAU OF ELECTRICITY ~' · ,. ~ THIS CERTIFIES THAT in the followi~tg location; [] Basement [] 1st FI. FIXTURE FIXTURES ~ 2nd Fl, 0~ Section Block Lot DRYERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R ,V I C NO. OF Hi-LEG A W, G, NO` OF NEUTRALS A W G, OF HI-CEO O~ NEUTRAL This certificate must not be altered in any manner; return to the office of the Bbard if GENERAL MANAGER be identified by thei~ credentlots. IN ANY MANNER.