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Home My WebLink About10139-zBUILDING DEPARTMEN Examined.. Approved ...... /.(..: ..... , 19... Permit No/. .......... TEL.: 765-1803 Application No. 2. ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ... J.c~..~.~.f~C>.}~ .... 19'~.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 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 occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buklding 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 regulations, and to authorized inspectors on premises and in buildings for necessa inspections· . admit Si~ ~~4~.:~' · ' 'i 'n' .... (-_/(Signature of applicant, or name, if a corp at'o ) .:-... fl.¢ L ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ .......................................................................... Name of owner of premises . .~. ~fi .~.'... ~77.~ .Z: ./~..?'.7.~.. Q./~..M,'. b~. q/L/. ' (as on the tax roll 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 .................................................. ....................... u m.1 .................. rut: ............... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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 ....... I.~..~'.>. >. ....................................................... b. Intended use and occupancy .................................................. FORM NO. 2 TOWti OF SOOTHOI. O BUILDItiG DEPARTMEtiT TOWN CLERK'S OFFICE SOUTHOLD, ti. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10139 Z Permission is hereby granted to: pursuant to application dated ................................... ..~....~..~f....../...~ 19_ ., and approved by the Building Inspector. .e ....... Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS ]-f~J~ BUREAU OF ELECTRIC)TY, ~ B5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only ttie el~tricol equipment as described below and introduced by tim applicant ~a~ed on the above application number in the premises o~ in the follotving location; ~ Basement ~ 1st FI. tvas examined on FIXTUR~ FIXTURES [~ 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO, OF HI-LEO NO. OF NEUTRALS 4 This certificate must not be altered in any manner; return to the office of the Boord Li0#1227 ncorrect, inspectors may be identified credentials. COPY FO. aUlLmNG DEPARTMENT, ~.IS C0P'~ (~ 3. Nature of work (check which applicable): New Building .......... Addition . ..~x, ..... Alteration .......... Repair .............. Removal .............. Demolition ........... :.. 'Other Work ...... .15 . I f'- (Description) 4. Est~nated Cost : 6/~) 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 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 . .~.0. ~.T: ..... Rear ,..0,0..~..T. ..... Depth . 1.~..~..-J~. ...... Height ... J.tg. ~..T. .... Number of Stories ......... J .............................................. 9, Size of lot: Front ...'~fl: F.T~- ............ Rear ...~.' .~..-~. ............ Depth . .~/~.~.-/~.~.../~T-, ...... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated... ~. h~q.}/l(.~:.~:_~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ... ~ D ..................... Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises ~..~. Zz. ,..~..t,vS:o..rf.. .... Address C,~TC~/]a ~. t/cC: ....... Phone No.?.2 q? t~.~ q~. ..... 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, interior or corner lot. --~ C~TY '. '.~~ ............. being duly sworn, deposes and says that he is the applicant O ~~1 signing contract) above named. ~e is ... ..................................................................... the (Contractor, agent, corporate officer, etc.) of s~d owner or owners, '~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are tree to the best of his knowledge and belief; and that the work will be perfomed in the mmner set forth in the application filed therewith. ...~~.~ ........ day of(: ... ,19~. .............. '~001 p'F. TO