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Home My WebLink About12971-z 1~0~ NO. ~ TOV~'N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 12971 Z Permission is hereby granted to: · .~.~..~~....~..G ....... L!..~..~..~.. ,o ....~~ ...... ~ ~'~' '~ 5:-L.~:~.~ ...~ .) ........ ......... .......... ........................................ ; .... ~,~5~.~...~.~.....~. .................. .~ ........ ~q~....~.....~ ....... ~~.~.. ..~.~..~.h ............................................................................................................................... ~ ~ ....... .~.~ ..... lot ~o ..... .~..~ ...... Coun~ Tox ~op ~o. 1000 Section .......... pursuant to application dated ........ (~'~ ~-,,' 0~.~..~.....~ ..................... , 19.~..~.,bL[ and Building Inspector. Fee $.J.....: ............... approved by the Building Inspector Rev. 6/30/80 F I E L~'~ IN~ PECT ION 1. FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under buitd[ng permit no. 12971Z issued to Herman sills on 4/3/84 for Accgssor~ is completed and a final inspection ilas ( ) has not (x") been done. % ' In order to complete thio file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for '$10.00 payable to tile Town of Southold. Please indicate to Whom tile Certificate of Occupancy ~s tO be mailed, and arrange with this office for an inspection date Occupancy or use in unlawful without a Certificate of Occupsncy. Please help ns to clear up this matter ao that legal action does not [lave to bo taken. Thank you for your prompt attention. Very truly y~, Victor Lessard Execut ~ve Administrator VL:gar C~lC 1 . 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL veOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined0- 3. ...... Approved . .~..~.... 3 .... , 19~. I. Permit No. 1..~. 9.?/. ..~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Sfg'ffa~9~_ .apI~'cant, offname, ifka corporation) ...&. .... (Maifing address o~ appfican[) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ..~. ?...~.~.~ ............................................................................. ............................ -~:..% .%. .......................... (as on the tax roll 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 ~rade's License No ...................... 1. Location of land on which proposed work will be done ................................................... · ...... House Number S~de)t Hamlet County Tax Map No. 1000 Section ....~..~ ..... Block ..... &.~.. ....... Lot...~.0.~ ......... ' ........ x ........... Subdivision ................................... Filed Map No ...... Lot (Nanle) 2. State exis~ng use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ...... ~ ~. -5.. ( ~ ~ ................................................ b. Intended use and occupancy ..... .~-~.qk4h4....(M~.. ~....~... (..~.~.~.'-~.~.~..~...~..~ .% .~.) .... 3. Nature of work (check which aPplicable): New Building ..... ' .....'Addition .......... Alteration, .~ ........ Repair ...... Removal ............ Demolition . Other Work... ?. .......... ~ oo/ ~ ~ c ~ (Description) 4. Estimated Cost.....ff~..a.../.. i ......................... Fee.~ ......................... ~ ~-- (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ........ ;zw. .... Number of dwelling units on each floor....-T;. ......... If garage, number of cars .... i · ~)~ %` ............................................................ 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use .... '...'-7 ............. 7. Dimensions of~existing structures, if any: Front .' ...... .~..~..~7... Rear ..... .~.fw ..... .Dep. t.h... ~.-.¢.4:. ...... Height ..... 5.~ ....... Number of Stories... P. ?.?-. .................................... Dimensions of same structure with alterations or additions: Front .......... '.-: .....Rear .... ~. ............. Depth ............... ~.. · i · · Height .......... -: ........... Number of Stories ..... -: ............... 8. Dimensions of entire new construction: Front ....... ! ?.g..4,. Rear ...... ~.~.~.¥ .... Depth .~.~.~. N mb ofSt ' .¢..~...~-r Height .. u er ones ..... Size of lot: Front .... ~ ....... Rear ...................... Denth ....................... Date of Purchase....C{ .}0)q ,..., .. · .~ 1 '~ 5 5.....~- ....... Name of Former Owner .~r~0. g~'.~...~ ¢ .0..&.~:~ .~.[ ~_,~, ...... Zone or use d~stnct ~n which pr~mlses are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...W'.? ........................... Will lot be regraded ........ .~. .................. Will excess fill be removed fron~_p.rem~ses Yes No Name of Owner of premises [~..e-~.¢5~r .~.~..~¼\.x .~. ~.t hk, Address. .&,.[.~.s..~r.(~ .% .-c:-.~l,l~e No...~.?.7. 7.q .C.'o.... Name of Architect ......... [ ................. Address .... .~.~ .~.~.~.~.o.A.g.. Phone No ............... Name of Contractor ........ i ................. Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocki number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, !S,S COUNTY OF ................. ............................ i .................... being duly sworn, deposes and 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, and is du!y authorized to perform or have performed the said work and to make and file this application; that all statements conthined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworu to before me this ........... 3,A~ ....... day o}..~.. ........... 19 .~.f Notary Public ...... ~..~...~..'~...f-J..f~.... County ~4()1 ^1~¥ ?LIiiHS, St¢((~ 01 Now ¥0~,1~ ............................... b~o 4'107 ~/8, Sutl01k (',t~m~L~ ~ (Signature of applicant)