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HomeMy WebLinkAbout13429-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERNUT MUST BE KEPT ON THE PREMISES UNTIL FULL COJV~PLETION OF THE WORK AUTHORIZED) N? 13429 Z Permission is hereby granted to: /. ~ · . ....~......x....~..~..'t. ............................................ ~' ...~.~....~....~..:.....~,!...?...~ ........ ,o ...... at premises located at ...~..~./~-' O <~)~O~"~'"'{ ................................ ~.-~.*) ........ ~ ................ County Tax Map No. 1000 Section ..... ,{~...[.,,~, ..... Block ~ Lot No. ,,,~.,.,~, by the Building Inspector, Fee ~..t. .................... 'B1~ilcllng Inspector~ Rev. 6/30/80 FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION FERN. STATE ENERGY qoDE COMMENTS FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1802 Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERi, IT Date '/'~ q ., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 Southold, 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary lnspect,,io, ns. ~ (Signature of applicant, or name, if a corporation) . .Bey. 7.$..,I.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... O. mt.t, ............................................................................... Name of owner of premises...~.~ t.~.. ~...~#~....~.t&.~..~ 0.~..~.....(~.~k~; +.~ .................... (as on the tax r~ll or latest deed) If applicant is a corporation, signature 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 ...................... 1. Location of land on whichi0ro, posed work will be done...~. ............................................. ........ ..... o v.,,. House Number Street Hamlet County Tax Map No. 1000 Section ......... ~. ~ ...... Block ....~ ............ Lot. ~.~ .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..". ~,~¥.i[~...~.@ I ~.~i..~..~.~ t~.,.. { ~ .~i.~.4[~.~lllS.~l~ ............... b. Intended use and occupancy,~....~) .~. 9 ~..~.A.~... ~.. ~l~.% .~. t]lt-l~t. ~'.~ , .et ,~*; ~,~~']J~, '"m~'.~c,"-?*~ ,,n,~ ............. 3. Nature of work (check which ap'plicable): New Building ...~ ..... Addition .......... Alteration ...... , .. .... ,Repair ...... '. ,-.. '.T. Reln0val .............. Demolition ............ Other Work ............. '.. ~, ,' i , , ~-~ i ,~: :~; (Description) 4. EstimatedCost... ...................... Fee ,': ,' ,; d ~ (to be paid on filing this application) 5. If dwelling, number of dw~ ~j~fig units ...... ~ ...... Number of dwelling units on each floor....,i~. ........... If garage number of cars ...I..~ ........................................ 6. ~fbus~i~:`~6~m~rg~?~r~mi~e~c~upancy~spe¢ifynature~mdextent~feachtype~use ....~.. ...... , ........ 7. Dimensions of erdsting structures, if any: Front .1~.[...f ..... Rear . .~.[ .......... Depth.. ~ .......... Height ..... ~I ....... Number of Stories ... ~... .................................................. Dimensions of same structure with alterations or additions Front ~'~ Rear Depth. ........... ~ .... I.. Height ...... ~ ........ iii ~q'u'mberofSi;~ils .... iii... 12 iiiiiiiiii 8. Dimensions of et}tire new c* onstruction: Front ...... .~ .* ...... Rear ............... Depth .~.~.'. .......... Height ..... ~ ......... Number of Stories ............... ' ................ ~ ............. 9. S,ze of lot: Front .~,~.~ .... f..: ........ Rear... ~.,~O...~. ........... De~th . .~ ~'.~.~ ............. 10. Date of Purchase .... Ih.V. ~ri ~[~ ............... Name of Former Owner ...~.~.~.¥J~ ~. ........... 11. Zone or use district in which~'~mises are situated...~. ~ .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . .~.$ ........................... 13. Will lot be regraded .......... i .......... Will excess fill b~ removed from premises: Yes ~ 14. NameName Ofof Owner of premises 'W~', ~, i $i~1~ ii~k .... Address .~*~.~. -- ,,..,~,~'~'~' ...... 'lld. Phone No. ~.~ ?. ~ ~ ~ 91. .......... ................. Address .... ~.ffi.g~.~.[.~ lllq~ Phone No ............... i. Architect Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block dption according to deed, and show ~reet names and-inltli~at~hether interior or coruer lot. DATE: }\?/~,,.},. FEE:JO' -- BY: _.~ NO-I:IFv B' 'l q NG DEPARTMFNT Ar 765-180'2 9 AbA TO 4 PM FOR T FOLU.3~, ,lNG II%*-P ECTION S: ]. FOtJN,-.A~q©N - TWO REQUIRED 'FOR pgl}RT~D CONCRETE 2. ROUGfl - FRAMING & pLUMBING 3, INSUt.Aw'~qN ALL CON~¢TR!ICTION SHA-L ~ECF ', THE REOInREMENTS OF THE N.Y ~ STATE CONRTRUCTION & ENERGY cODES. NOT RESPONSIBLE DESIGN OR cONSTRUCTION ERROR~ ~0' STA~ OF NEW ......... ...~ ............. ' .............. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the .......... ~ ~ ................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perform or have perfomed the s~d work ~d to m~e ~d file ~s application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that ~e work wDl be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this Nora, Public, ~~~nty ~ ~~ .... ~.~ .~ &~. C,X,, ............... ~~rM ~ ~, 1~ (Signature of applie~t)