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Home My WebLink About11476-z FORM TOWN OF SOUTHO~ BUILDING TOWN -HALL SOUTHOLD, N. Y. BUILDING PERMIT ~' (THIS PERMIT MUST BE KEPT ON 'I;H,E PRE/'~I5~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) No. $147(; Z Date ..~.~.&~,~.~.~..,..~...?.. ........ , 19...~.../. Permission is hereby granted, t~g~_ ..~;~ .......... ~.~..~ ............. .... ~...~z:~.~/2...-...~..:~:~...,....i ................. !, , .... ........ .................... ._; at premise~ located at ..~.~..Z....~...'....~..~~..~.....,..~,...~.,.....~...,..;..... .... ~., .......................................................................................... ,....~...~. ~,a~..-./~..-..~...-.~... ...... ........ ":--k,ounty Mop No. 1000 Section ..... .k,x..._..~..:. Block :..g~'.../.. .......... ~Lot No..~)./...~... ......... pursuant to application dated ............................... , 19 and ~pproved by the Building I~spector. Fee ~$ .............. Rev.;6/30/80 i ~- : FIEL~ I~%FECTION COMMENTS ,,_.~ "~ FOUNDATION (~st} FOUNDATION (2nd} 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197't TEL,: 76'5'1802 - ^pplication No ........... Disapproved a/c ....... '. ......~ .'~. ........ ,,e'. ........... (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 tt:e Buildi Inspector. with 3 sets of plans, accurate plot plan to scale. ][:ce accordiu~ to schedule. b. PIct p!an showing location of lot and of buiklings on premises, relationship to adjoining premises or public stre~ or areas, rind giving a detailed description of layout Of property must be drawn oil the din~am which is part of this apl- cation. c. The work covered by this application may not be commenced before issuance of Bulk!lng Permit. d~ Upon apprc.'al of this application, thc Building Inspector will issue a Building Permit to the applicant. Such pern ~llall be kept on tile premises available for inspectioi1 throughout tile work. e. No buildJ~!g shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by tile Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordiuance of thc Town ~f Southoki, 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, buikling code, housing code, and regulations, and admit authorized iuspectors on pr~miscs and in buiidiags for necessa~)~pections../ ~r~.~/.~'~'~ '~'" '~' ' ' ~'~5~;at~<~ir~e o~ ;[~plica;~'tl ;r ~ame, ...... ifa corporation)' .......... ../~/~. ~.~. ~. . (Mailing address of applicant) ' ~ Stale whether applicant is owner, lessee, agent, architect, engii,~cer, general con/fac!or, electric/an, plumber or build (as on the tax roll or latest deed) "~,, applicant is a corporation, signature of duly authorizedof,,c~r. officer) (Name and title of co~.firate ~,i~de~'~ License No.. A ~~/2..'z'"' ./~,CC~----- ::~ ?~ ' Plu nber s L'cens.~ No Electrician's License No ....................... Other Tradc's License No ...................... Location of land on which proposed work tvill be done ................................................ ../.4,e...w. ........... ~..~..~/.~..? .... /7~. ..... .~.<~. :/d?../d...w.:/. .......................... House Number Street Hamlet Couuty Tax Map No. I000 Section ...... ~ .C?..7 ...... Block .... .~...~. ......... Lot d / ~ Subdivision.. ,~-¢d;<7./--/-~..~. ;~...w~...-~(. .... ....... Filed },iai, No....c~.../...o~..... Lot.. ;/.~f .~.../..~:~. (Name) State existing use and occupancy of prenlises and intended usc al~d occu[~ncy of proposed construction: b. Intended use and occupancy .dy~.,_? . .,/~x,,/. ............................ ,, .'.~ !:e of*,vo:!: (cl:eck wh!d' applicab!s): .N~.a ",:' "'. Remm al Dc;noliuon Other Work Repair ' (Description ) iZzi:nated Cost ...................... :: ............................ .-- .... (to be paid on filing this application) If dwelling, number of dwelling units ............... Nnmber of dwelling units on each floor .......... If garage number of cars ' · If business, commercial or mixed occupancy, specify nature and extent of each type of use ............... : Dimensions of existing structures, if any: Front... ' Rcar .............. Depth..; ...... . lleight Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ............ Depth ' Height Number of Stories L Dimensions of entire new construction: Front ............... Rear ................ Depth ............... Height ............... Number of Stories ............................................. ~ .......... ) Size of lot: Front ' Rear i Depth ) Date df Purchase Name of Former Owner I Zone or use district in ~vhich premises are situated ~ '. Z. Does proposed construction violate any zoning law, ordinance or regulation: . .' .............................. t. Will lot be regraded .......... ' .................. Wil! excess fill be removed from premises: Yes No L Na~ne of Owner of premises .................... Address ................... Phone No ................ Name of Architect ' Address Phone No Name of Contractor Address . Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an&recreate all set-back dtmensmns from mperty lines. Give street and block number or description according to deed, and slmw street names and indicate whether terior or corner lot. i'ATE OF NEW/YO'RK,., ~,~ _ _ O~NT.Y -o-F: ~.~:~.'... ~' ~_~--, ~/{Nanie of individual sigwbTg contract) . >ore named. being duly sworn, deposes and says that he is the applicant e is the ................. ~ ................................ ~ .............................. (Contractor, agent, corporate officer, e.tc.) .r sakt owner or owners, aa~d is duly authorized to perform or have performed tile said work and to make and file this )plication; Omt all statements contained in this application are true to thc best of his knowledge and belief; and that the ork will be performed in the rammer set forth h~ the application filed therewith. a.om to before me this ~ "~Jk~d~ Suffblk ~ou~ . ~ .4 .t .... ~~ ............... " . . Term ~xp~res March 30, 19.~ ~ (Slg~ature ofapphca~t)