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HomeMy WebLinkAbout11305-z FOl/~I ~TO. 2 TOWN OF, SOUTHQL BUILDING DE*PARTME TOWN H~LL SOUTHOLD, N~.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S COMPLETION OF THE WORK AUTHORIZED) UNT L FULL N©. ~[ 1 3 1) 5 Z Date ....... ~/~ ~..~. ............................. , is hereby granted to: ~ · Permission ......... ./.'.~.~.~.i..~~..:.~ ................ ..~ .~....z~...~.i~..C..~.~) ,a..,~..~..'...~ ....... ~.~.~.:~ ......... ~C~ ....... ~.,,.~,'~? ............................................. at premises located at ........... x ........ -. Coun~ Tax Map No. 1000 Section .......... Bloc ........... Lot No..(~ ....... i....., 19~, and approved by the pursuant to application dated ........ i ................. Building Inspector. ~ Building Inspector Rev. 6/30/80 FIEL~ IN~L~P ECT I ON FOUNDATION (Ist) FOUNDATION (2nd) 2J ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY O,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Exam,ned ~--~..w2~. ..... t9.OO./. Application No...d'./..~.(?¥. ...... Approved ..~ ~....~..'= ....... 19~./. Permit No. Disapproved a/c ....... : ...... ; ~.: ....~--....//. ......... /') · , (Building Inspector) ' /3,PPLICATION FOR BUILDING PERMIT Date ...~.~k. :/...~./ ....... 19~.1 INSTRUCTIONS a. Tins application ~nust be completely filled in by typewriter or in ink and submitted in triplicate to the Bmldi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according tc schedule. b. Plot plan <bowing locatmn of lot and of bmldmgs on premises, relationship to adjoining premises or public stre~ or areas, and g~wng a detaded description of layout of property must be drawn ou the dia~am which is part of this apl cation. c. The work covered by this apphcation may not be commenced before ~ssuance of Building Pem~it. d. Upon apprc, al of this apphcation, the Budding Inspector will issue a Buitdmg Penmt to the applicant. Such pern shall be kept on the prennscs avadable for inspeclmn throughout tho work. e No bmlding shall be occupmd or used in wbole or m pa~ for any purpose whatever until a Certificate of Occupan sh~l bare been granted by the Btuldmg Inspector. APPLICATION iS ItEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to t Braiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Rcgulahous, fm the construction of buildings, additions or alterations~ or for removal or demohtion, as h~rein describe The applicant agrees ~ comply with ail applicable laws, ordinances, build~ code, housi~-)code, and regolations, ~d admit autb°nzed i"sgcct°rs °n Pz~m'scs and in buildings f°r necess~w inT~°ns' ,. ........ ,,. ......... 6..9 ..... ,.,..., ..... (Mailing address of applicant) -- State whether appScant is ownm, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ......... O.e.H e~ ........................................................................ Name of owner ofprennses .~.k).6{/T/....{_~.4.~7/~...~./~ ............................................... (as on tile tax roi! or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of colporate officer) Builder's License No ..... .~ tS.-.g.~ ............... Plumber's License No ........................ Electlician's License No ....................... Other TradEs License No ..................... 1. I.ocatlon of land on which proposed work wall be done...~..L.r.>.q..~.-.. [ ~.~?~ O~ . ~yO.¢~..0~. ~. t~.t. m, ,000 .... .4 ...... .4..4 ............ ....... Subdivision ................................... Filed Map No ............... Lot .............. (Name) 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: t. Nature of work (check whict, applicable). New Building .......... Addition .......... Alteration ,.... ~.~ .... Repair .............. Remoyal ............ Demolition ....... Other Work . .~.~'~(~ ' Estimated Cost ..................... Fee .............. ¢ ........... (to be paid on filing this application) ;. If dwelling, nuinber of dwelling units ............... Number of dwelling units on each floor.; .............. If garage, munber of cars ........................................................................ i. If business, commercial or mixed occupancy, specify ~ltture and extent of each type of use ......... ~ .......... ~. Dimensions of existing structures, ifany: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure wi;tit alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... ~. Dimeusions of entire uew constri~ction: Front ............... Rear ............... Depth ............. Height ............... Numlber of Stories ...................................................... Size of lot: Front ........... i ........... Rear ...................... Depth .................... Date df Purchase ........... : .................. Name of Former Owner ............................ Zone or use district in which prdmises are situated ................................... ". ................ Does proposed construction violate any zoning law, ordigance or regulation: ............................... Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Arclu~ect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... ; ................. Address ................... Phone No ................ ). I. 2. 1. PLOT DIAGRAM roperty lincs. Give street and block , tei~or or corner lo t. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate M1 set-back dimensions from mn:her or description according to deed, and show street names and indicate whether rATE OF NEgg~OR}~,~..~ .~ 'S S ~ OUNTY OF~. a.a ......... '..'. .... ]/. ~:¥~ 1,,m~h,l,being duly ......... sworu, deposes and says that he is the applicant (Name of mdMdual sign.lng contract) )ore named, r e is the ' ,: (Contractor, agent, corpmate officer, etc.) f said owner or owners, and is duly authorized to perform ,or have performed the said work and to make and file this >plication; that all statelncnts contained in this application are t~ue to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before hie this ~ JUDITH T. TERRY ~.03~g63 suffolk Coun~r/2 J:~ ~ ' ' (~ig, ature of appIica,O