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Home My WebLink About10793-z FOltM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S O~:FIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10793 Z Permission is hereby granted to: .......... ..... ~-~.~..../...¢..~¥~ .......................................... ....... ~..~:~..~..~.~.~.~...~.: ............ to ......... .~..d. Z,z.~..~...~.~,Z.z ~77..... ~,~.c..~..~.. £.-c~ .~.~,~2....~,~..xcz~..c,z.~....,~.....~. ......................... / otpre mises located at ./.(-4~'~. .......... ~ .....¢_.~2..~..? ........... Z.~..~ .~.../....~...~...'?...~.... ::.~...: ...... pursuant to applicatio~r,xdated ...................................... , 19. , and approved by the Building Inspector. / F~EL~INSPECTION COMMENTS FOUNDATIO~ (~st) FOUNDATION (2nd) ROUGN FRAME & ?LUMBING 3. INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO, 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To . *-.~. './~..//, .'O...,~2.~.. rog.~.~-a .f.,~). ...t..~. ~., .~.. /. /.40. .o ............. PLEASE TAKE NOTICE that your application dated ..... j~.,<./.~....F-~../ ...... , 19 Z~. for permit to construct.. ~..~.'~.~..~..~..c; .f~..-.~. ..... ~'/"?'5'''' '/' .................. at Location ofProperty 9~ e~ ..... ~L~.. 3.Z k't[o$[ .......... ~m'~C'r~'~ 7- County Tax Map No. 1000 Section .. [~ ~ ...... Block ...O. ~ ....... Lot . .~/ ...... ~' d M p N Lot No. - Subdivision ................. File a o ..... ~.~---~,: ....................... is returned herewith and disapproved on the following grounds. ,~..0'...~'~, g,4. ~o~o~z~.~...~~.(~5.~ .... ~o~;~..¢xO ...... V' Building Inspector RV 1/80 FORM NO, ~l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined~/.y..d: .... , 19~ /d ~9~- ~, Appli~:tion No. ~ ....... Disapproved a/c ...................... ~ ...... /J ~. (Building Inspector) · APPLICATION FOR BUILDING PERMIT 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 applicatzon may not be commenced before issuance of Buildzng 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 qccupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildzng 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?~e, and regulations, and to admit authorized inspectors on premises and ~n buildings for necessary inspections. / .' (Signature of applicant, or name, zf a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~ .-~.~...J~.-? .r~. · ..................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and tztle of corporate officer) Builder's License No ....... Plumber's License No ......... ...~ ....... Electrician's License No.. ,,~>>~: ..... Other Trade's License No. ~. .................. 1. Location of land on which proposed work will be done..~,~..~ ,~>~.} .~.~..J~..~. .................... -' ..... ....................... House Number Street ~ ~,' Hamlet County Tax Map No. 1000 Section ................ Block ...; .............. Lot ................... Subdivision.../Vor~ .............................. Fzled Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~ .0~..~¢~t~ ............................................... b. Intended use and occupancy ...P4.~7~. ~,a~l~. ,~o. ~. ~1e~. ~.~..~ ............ M~ '~ c~.~ ~ ~.~:~ ~-~ ~, ~. e ~,4 ,, 10. 11. 12. 13. 14. Nature ofw°rk (check which applicable): New BuL ing t ... Addition .......... Alteration .... ......... Repair .............. Removal .............. De~molition .............. Other Work.. ~r,~v~,ag.... .... Estimated Cost ............. I ......... ' ................. F~~'~ ~ 'r~e,a't~;;~' .... If dwelling, number of dwelhng Units ............... Number of dwelling units on each floor ................ If garage, number of cars ....................................................................... If busihess, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing structures, ~f any: Front ............... Rear .............. Depth .............. Height ~. ~?0. ~-,~.. Number of Stories. 00~ .............................................. ~ .... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Heig~ht ...................... Number of Stories ..................... Dimensions of entire new constrUction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....... ' .................. Size of lot: Front...~0,0..~ .~4~ .......... Rear.. ~)i/~i i i i i '. i ' i);~it~ ' i~i 185~. ~-~ ..... Date o'f Purchase ...,7~ ................ Name of Former Owner ............................. Zone 6r use district in which pr~mises are situated. ~ ~' #~,~t~/,~,#aI Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded . ~/4, ..... i ................ ;.. Will excess .fill be removed from premises: Yes ~O No Name of Owner of pramt$~/~ . $,~. &. ~: Address .~4~. J~O~,. ~.~one No. $??.-'1014[..(.~..).t. Name of Architect ............... Address ................... Phone No..~,~.J?:~>.o~'..~'.~.(.,B..~/~ Name of Contractor . .t~../[.~. . ........... Address ....... ' Phone No ....' ...... .. · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from lines. Give street and blocki number or description accordang to deed, and show street names and indicate whether interior P'//DZ~],E ~b~qD ~,.~ 9-7 STATE OF NEW ~ORK .... ..... 4.~AA~.. ~,.. ~ ~ ~ ..... : ...... being duly sworn, deposes and says that he is the applicant ' (Name of individual sig~ing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly autho~zed to pe?form or have perfomed the said work and to m~e ~d file this applicatiog; that all statements con~ained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the man,er set forth ~ the application filed therewith. Sworn to before me this ' , ' ~ qualllte "~rch 3~ t~ i (Signature of applic~t) I Co~tSsion Expires ~