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Home My WebLink About11038-z i FORlIl NO.2 1.. , ,-' B~~irl~gFtt~t~~~tJ TOWN. HALL . i , SOUTHOLD. N'. Y. \; a' t ,. BUILDIN.GP,ERMIT;, , -,;, " " . ., " f (THIS PERMIT MUST BE KEPT ON TH~, PRE0IS~S UNTIL P,ULL COMPLETION OF THE WORK AUTHORIZED) ; . ,. , " \lD I b No r 8u J J.... r . N9 11038 z . " I' ." ;' -:+:: ' , """i!F~"e l;",y" ., 7 (7/ . Date ......r'1!'......"'.&f~'7'.....:v.\.. ....., 19..0./ , r , ., Permission is hereby granted to: ," ."-~ ' !. :* " .......k!r:...I/.k.9..i?.t./.....Nur.e.:rVur.. :...7.<..-;lc. . .......WO'<.Q.d.....~A.i(........i....:,................;. <"'" " ," , . ......-bC,(.r.t-LO.4'L;7:..U...~~................;. . to ..t.9..I.Y.:T.f.(:,.~.b-:?::....(9,r.w'./.T.J..Q.I:I.i....-:I..a .....M.A,.~~~dl',lfl'i'...FG'OU.MZ?(;.C.l~.i-. ,udi.t:r.::'!,;;c.~......q..tC;'fii:e;p#ac<..sc......:. ..............,{;...;:................:................................. ....... otpremises located at lZ'r:':'a:~.,:.v.f.~dy..&?"'g..~p...~.l:............:.......................... o?P/05/v.pa'7/A..~.f~t"" . ~ . ............................................................1<::.:6..:...... .1'..:...~fI./..{t1J27'j:.......ICU;/7#O'~I'Z.:-:;U I . ..~... .~...... ... ...,........ ....... ...........................'.. ...~..... ...... ..... ",' ....... '1~' "~r'" ..... ......~. f.............;. ............ ............. Cau~ty Tax Map No. 1000 Section ;.c>.6':~...,.... aleck, .\..41...2......... ;.tat No...QCl.5........... purs~ant to application dated .E""~."'d.~....~4.t..., 19:J.:f.., and approved by the Buil4!ng Inspector. ' t ;: . ~ I' ~' :( ~ 15qs1 Fee ~................"...... r ':; !:' ~: g~ F i " 1: t ,j: :; Rev. :6/30/80 i i ~ ;;.. .,' ,:.I,..~ " ,L", ..,Al....~"'_,lll.h.tl1::Ji-;,.<'''"';&~....,o..:,' '. 1, '; '. . ,;, K ; ~ . . :"t; II ,iF '.,'\."j;...'.....;i...,.if""'...,".d..",.L ...'.,,(,....~ ,.d,;'.~...". R '. .L,' ;...<.~..,.~....: ,;" __. _~_...-.~;~B.ii.-._~~~.1')~ ,._"....:lliiilti.'.L111;_ ',1. '~ii.. <..1c... : .,,~. F~'~,~ I~SPECTION FOUNDATION (1St) FOUNDATION (2nd) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CO~E FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined...~.~..~.....~..7--, 192~ Approved ......... '.~.~...., 1 . Permit No././..~.. Disapproved a/c ........ ;....~. .................... ../ ...............· .¢¢¢X%. - · .% .'%. .% .'77. .'w. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.../~.O. ~...~..~. ..... 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 Building 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 $outhold, 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 admit authorized inspectors on premises and in buildings for necessa~ inspections. (Signature of applicant, or name, if 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 .... r~ .' .... &.. (as on the tax roll or latest deed) If~licant is a co~or~n, signature of dally authorized officer. (Name and t~ co¢orate officer) Builder's License No .......................... Plmnber's.License No ......................... Electrician's License No.. t<d...o. ~td.~....-: ......... Other Trade's License No. 3~. ................. (~ ~:~/0.~ 1. Location of land on which proposed work will be done ....... C°..~'..'tN~ ,~'... ............. ~ ~\~-.....(k]OA~jV ~..... ........... ...... ............... ........ ............ ...................... House Number 2~ ,.,~o~ Street Hamlet County Tax Map No. 1000 Section ..... ~.O~. .......... Block ...... ~ ......... Lot...~ .............. i. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .~_~.~,0 9,~.. ¢j.~.~-0.,.C~.~. \ .-~.¢..ct~. ..... '.~.~.0~..~..~ ..................... 3. Natur~ of work (check which applicable): New Building .......... Addition.. .... .... Alteration .......... Repair .............. Removal ............. Demolition .............. Other Work ............... . Estimated Cos . . .: ...... 5. If dwelling, number of dwellingiunits ............ (Description) (ti> be paid on filing this application) ·. 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. I)imensions. of?xisting structures, if any: Front..~..0.c ......... Rear . ..~ O.t. ...... Depth...'~q~'. ........ Height .. 1 .o.: ......... Number of Stories ...... .~..~..~. ......................................... , .... Dimensions of same.structure with alterations or additions: Front ....~. O. ! ........ Rear .~..'7~-~;.4r'. .(~..O(d.t~.t:a.\ Depth....~. !/~5.' ~' ........ ;.. Height .[ .~..~.~.~..}Z. .......... Number of Stories....O. B,~_.~. ~.~... ~... ,..' 8. Dimensions of entire new construction: Front . . . Rear ..... Depth ~.~. Height ~. Number of Stories...~ ................................... ¢"z ,. .... r4~O t. ~ ~ ~ , ~. ' 9. m e o~lot: Front ....... ~ , Rear ...~{3.Q .............. Depth ...................... 10 Date of Purchase ' Name of Former Owner 1 1 Zone or se dist ict in wh'ch p bm' 'tufft d · U r 1 r lSeS are si e ..................................................... 1 2. Does proposed construction violate any zoning law. ordinance or regulation' 0 .O. ............ 13. Will lot be regraded ....{~..Q ......... k--e.,,~ -I~owo~"~ ........ ~ .,... Will excess fill' be removed from premises: (~es'~ No 14. Name of Owner of premises .~; ............ ~. ~. Address . .~v~ .~... ~..0~.~.. Phone No..3..~.~toO~.. Name of Architect ......... ; .................. Address .. Phone No ................ Name of Contractor .'1~?.."?~,&.. '~b~.gV.~..~.. IBC. Address i~14.4~. ' i i i~ Phone No..'72 I~S'.~. ~.o. ~... 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. cou t¥'d: :s.s^ ........ .C~..~..~;~,.!...~... beingduly sworn, deposesand says that he is the applicant · (I'~ame of indivflual signm~ntract) above nmed. He is the ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perfom or have perfo~ed ~e said work ~d to m~e ~d file this application; that ail statements contained ~ ~this application are true to ~e best of his ~owledge and belief; ~d that the work will be perfomed in the m~nek set forfh ~ the application filed therewith. Sworn to before me this