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HomeMy WebLinkAbout11358-z TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR · P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 aant This is to advise Permit No. i~1~' issul on ~\~. for a fYnal nspection na that the unde In order to corn: ete a Certificate of enclosed form(s), check for $5.00 indicate to who the Certifies and arrange this office for Thank you this ney be issued. return same to the abo~ own of S as ~mp!eted and been done. ~ecessary that fill out the office with a ~. Please iS to be ~ ~ ~ ~ec~ion date. your prompt attenti Very tru[ yours, ~ Victor Lessard EV~Cosure~ ~ ~ ~Adm~nls~r~or. BUILDING PER~!T: (THIS PERMIT MUST BE KEPT ON THEPRE/~' SES UNTIL 91ILL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: : i ; ' :i ..................................... ,. ........... 7,.....~ ....... ~ ' Ou,ldlng Ins~ecto. Fee $..~5...~.;.- ............ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....... ..~.. ?../., 1 .9~. Approved ...... .~.~..5.. ?./., 19~.. Permit No.../. (. ~. Y~. ~..~ / - Application No ................ (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date..~. V?. ~?.~... ~ 19~.(' a. This application must be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF 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 pern 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ...... applicant, orfffame, if a corporation) ........ '1' ' ' ....... t' .... :, -,' .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild( .......................................... . .......................................... Nane of owner of premises ~V~ ~ I l-'hz~O {~' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized officer. (Name and title of corporate officer) Builder's License No .......... ~.~.'>5¥e. ./.K..<~.. ~... Plumber's License No ......................... Electrician's License No ....................... Other Trade s L~.ensc No. 1. Location of land on which proposed work will be done. ~ ~ O ee..O el/fi,__-O ~-o'T Ok3 House Number O&2 Street Hamlet ' -0>}~ ' : ' County Tax Map No. 1000 Section ... ~e'~.~ ..... Block ~ ................ L~...~c. Subdivision (Name) Filed Map No..~. ~.~. Lot ,. 2. State existing use and occupancy of premises and intended use and occupancy of proposed constru6tion: Existing and occupancy . . . ~ ~e'~ a. Hse . b Intended use and occupancy '-- Sg~D ~ ~(~ ~ ~OOt~~ ). Nature of work (check which applicable) New Building ~ Addition Alteration - Repair .............. Removal ............ Demolition .............. Other Work ............... .~. 7.0.0. Fee .~..~ ~ (Description). Estimated Cost ................................................ ~. ........... (to be paid on filing this application) ;. If dwelling, number of dwelling hairs .............. Nmnber o f dwelling units on each floor ................ If garage, number of ears ..... .................................................................... i. If business, commercial or mixed occupa t. Dimensions of existing structures, if any: Height ............... Number of Si Dimensions of same structure with altera Depth ...................... Heigl: /. Dimensions of entire new construction: 1 Height .... .~.~ ........ Number of }. Size of lot: Front ....... {50..~ ....... ). Date df Purchase . .~...eEC'°..'r~.~, .i~...t.q.'7..' I. Zone or use district in which premises ar, 2. Does proposed construction violate any ). Will lot be regraded ......... .~'9'..© .... *. Name of Owner of premises Name of Architect .............. Name of Contractor ........... :y, specify h~ture and extent of each type of use ..................... Front ..... J ......... Rear .............. Depth ............... eries ........................................................ :ions or additions: Front ................. Rear .................. t ...................... Number of Stories ...................... 'rent ..... L'~..~ ...... Rear ...... } .Z:.' ...... Depth ....~. ~. ..... odes ........................................................ ........ ;.. Name rmer Owne .... I ........ : situated ................................... ' .................. oning law, ordinance or regulation: ...... .'15{..O. ................. [.~,, · · .. .......... Will ex,ss fill be removed from premises: ~ Yes ~-~'No ~..~.re:l~p,~q..O. Address . . .~, ?..t q-. ~ .~.~ ....... Phone No. "/~.¢.-.,~t~'.q.~ .... ......... Address ................... Phone No ................ ........ Address ................... Phone No ................ Locate clearly and distinctly all buildin roperty lines. Give street and block!number ;terior or corner lot. PLOT DIAGRAM whether existing or proposed, and, indicate all set-back dimensions from description according to deed, and show street names and indicate whether FATE OFNEW YORK, OUNTY OF.. ~.M¢.~.O.L. [<:; ..... S,S (Name of indMdual signing cent ~ove named. e is the . .~ ....................... f said owner or owners, and is duly autho ~p lent)on that .all statements contained in 'ork :will b~ performed in the ~anner s~t for worn to before mo this : ........ ............... day of .... '. ~yPfibl'ic, '. ........... ........... being duly sworn, deposes and says'that he is the applicant iContractor, agent, corporate officer, etc.), 'ized to perform or have performed the said work and to make and file this this application are true to the best of his knowledge and belief; and that the :h hi the application filed t~,erew th. co. t ' ~,~ ~ f :,,/ - ~ (Signatu~ of ~pplicant)