HomeMy WebLinkAbout11335-z FORM NO. 2
TOWN O~ S~UTH~Li~
BUILDING DE~PARTME~3
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT!
(THIS PERMIT MUST BE KEPT ON THE P~,E~IS~S UNTIL
FULL
COMPLETION OF THE WORK AUTHORIZED) i
11335 Z Date ...... , ........
Permission is hereby granted to~ ~ /__
Fee $.../..'..i ...............
Rev. 6/30/80
~.,, ......... Lot No..~)/~L~ ............
..... , 1 ..~..~..~ and ~pproved by the
FOUNDATION (qst)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
3.
INSULATION PER N.
STATE ENERGY
G,ODE
FINAL
ADDITIONAL COMMENTS:
FORM NO, 1
" TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .~C4Z~,~ F ~ , 19'df)
A ppro,'ed~./.~ 7. ..... t~/.. Pem:it So.. (./.~').~(..
Disapproved a/F. ....... :.'7.~.. ....................... ; '
APPLICATION FOR BUILDING PERMIT
Application No..././.~..~.~,'7 ......
INSTRUCTIONS
a. Tins application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi
Inspector, w~tb 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 detmled description of layout of property must be drawn on the dla~am which is part of this aPF
cation.
c. The work covered by tlns ~pplication may not be commenced before issuance of Building Permit.
d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern
shall be kept on the prennses avadable for inspection throughout the work.
e. No bmldiag shall be occupied or nsed m whole or m part for any purpose whatever until a Certificate of Occupan
shall have been granted by the Building Inspector.
APPLICATION IS IIEREBY 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 tile construction of buddings, additions or alterations, or for removal or demolition, as herein describe
The appbcant agrees to comply w~tb all apphcable laws, ordinances, building code, honsing code, and regulations, and
admit authorized respecters on prenllSCS and In buildings for necessary inspectio~s..~__
(Signatt~-°f , if a corporation)
· .~-~. ~.~..(..~,.~ N/,~.ai.o.o.,..~.0~..d~d~.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build
Name of owner oft, rem,sos .~:~.
, (as on the ta~ roll or latest deed)
If applicant is a corporation, s~gnature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on winch proposed work wall be done ................................................
· .x. ~.~..si..~ .~.. L,,,,..,%., :.,,:,¥..m,-,, ,~.,,,,.. ..... t.~.~.,~$ ........................
ltouse Number ~ Street Hamlet
County Tax Map No. 1000 Section ..... ~.Q .......... Block . . ..~.. ............. Lot.. J.~. ...........
Subdivision .Pe~./~__g..t~.~1,..~.t.~ ........... Filed Map No..(~2..(q.(~ ....... Lot.. ~l ..........
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
....................
b. Intended use and occupancy.. 7~M%l..~4Z.....Q.~. ~. ~..~.~ .) ..............................
Repair .............. Removal .............. Demolition .........- - - Other Work. 1~.,, .......
~ (Description)
(to be paid on filing this application)
;. If dwelling, number of dwelling units -- - Number of dwelling units on each floor..; i... ':. .......
If garage number of cars ~-'
If business, commerm,l or m~xed occupancy, specify nature and extent of each type of use .....................
Dimensions of existing sm~,ctu~es, if any: Front 1'1~¢',
Depth . ..~,,,A~ .............. lleight ...'~ ............. Nmnber of Stories.. ~ .............
D,mcnsmns ot ,nt]rc new consWuct~on. Front ....G....o ........ Rear ...I~,.Q ......... Depth . .G.' ............
He ght . .~'t0'. ...... Number of Stories . iO[t~. ..........
Date of Purchase .0..~..~.,. Jka,.I.q.'[~ ............ N~ne of FonBer Owner a../~hb0,.~ .~,.~.{ tat., ....
Zone .or use ~district in which premises are situated. ~-,[.o.,~.,~v'~,.~04J.~.~vv~t~ ........... ' ..................
Does Proposed construction v~olate any zoning law, ordinance or regulation: . .~."~O ..........................
Will lot be regraded ..... ~.~l .................... Will excess fill be remi)ved fr,om premises: Yes ~/ No
Name of Architect ............ 2 ....i i 7' .... '... Address ...... '.5.:...-:-r:-.... Phone No ......... i ......
Name of Contractor ~ Add]ess' Phone No -
PLOT DIAGRAM
Locate clearly and distinctly ,'ill buildings, xvhether existing or proposed, and. indicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
tcrior or corner lot. i ,
"-' '"-,J
rATE OF NEW.YORK,
OUNTY OF .'~~ .... S.S
...........'_.,. ,t/ _ ~ ..;3.0[,v~ .~., .~.Oo ~..~.. ~ ..................... being duly sworn, deposes and says that he is the applicm~t
(Name of indMdual sighting contract)
)ore named.
e is the ""
(ContractOr, agent, corporate officer, etc.)
~ ~ ~ Cwncrs;- m3d is duly authohzed to perform or have pe~;formed thc said work and to make and file this
)plication; that all statements contained in this application are true to ~he best of his knowledge and belief; and that the
'ork will be performed in the manner set fort ~ ht the application filed therewith.
worn to before me this~
~ '
.. . '
ota~ Public,~
, ,' , m~ vor~
I ~, 52-0344963 SUffolk ~.n~
I ta~gnature of auphcant)
[HE sHo,~T
II
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