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HomeMy WebLinkAbout12892-z FOII~ NO. ~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12892 Z Date ....................................... Z- ...... Permission is hereby granted to: ...... ~Y.~......~....z~.~;:~ ............. ~_... ........ ...... ~.~..~.z/z~...=...~.......~....../../.f...z/ to .....C~ ~...~...//~..c~ .......... .~.........~ ........... .~..~../~......= ......~.~;.....z~ ~ ........ .............. ........... at premises located at ........... y~.~.....~2..~....:~....~ .......................... ..................................................................................................................... ~,~'/~.~Z~....-..~ ..~, County Tax Map No. 1000 Section ...¢~. ,~.. ......... Block ...~,.., ,<~,.. ....... Lot No. ~.,(.~..~.. .......... pursuant to application dated ...~:~.~..~.. ......................... , 19... nd approved by the Building Inspector. Fee $.,,./,,, ~, ............ Building Inspector Rev. 6/30/80 FIELD II~SPECTDON ~ IDATE COMMENTS FOUNDATION.~ (1st) ,, ~FOUNDATION (2nd) 2. ROUGH FRAM~ & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO, 3 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date ................. ,19 . · o...-Y_e~c.~.~c~.z~.. ~cz....~..,~7,z,~,~~ ~-O.-...~v. ...... /~.,..~ ............. .~.~.7~o.~.& ~: .~..~ ..... PLEASE TAKE NOTICE that your application dated .. ~ ..... ~ ............ 19 ~ for pe~it to const~ct .... ~.~ ~ ~ .. at Location of Property . . ~. ~(~.'. ~ouse No. ' ' ' ' Stm~i ............. Hamlet County Tax Map No. 1000 Section .. ~ ..... Block .. ff~ ....... Lot ~ ...... Subdivision ~- Filed MapNo..... .... ~........ LotNo. ' .... is returned herewith and flisapp~oved on the follow~g grounds ...~~ ~../~.~~ ~~- ~.. ~c~.. ~ ~.[~ .~'...~~... ~o/~ ...... Building Inspector RV 1/80 FORM NO, 1 TOWN ©F SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... ...... Disapproved a/c ....... "· · '' ................ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Ph)t plan showing location of lot and of buildings on premises, relationship to adjoining promises or public stre~ or areas, and giving a detailed description of laybut of property must be drawn on the diagram which is part of this cation. c. The work covered by this application 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 tile premises available for inspection throughout the work. e. No bull(ling shall be occnpied or used in wholg or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance cfa Building Permit pursuant to t Building Zone Ordinance of the Town ~)f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with nll applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary 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 build. N,'~neof of premises fi'{~t~$SP.~ % g~{~ (as on the tax roll or latest deed) If applicant is a corporation, signatme of duly authorized officer. (Namc and title of corporate officer) Builder's License No....~.~.~5." .................. Plumber's License No ......................... Elactrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ .... .5.3 .................. ............................................... House Number Street Hamlet Couuty Tax IVlap No. I0~30 Section ..... .~o] .......... Block .... .5/ ............ Lot..7. .............. Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..a' ; ....................................... b. Intended use and occupancy Nature of work (check whict 'pplicable): New Building Addition Alteration Repair .............. Rcnioval .............. Demolition .............. Other Work. ~ ............ · ~,:~.t'Mla'bo~ ~ ~ t't1~.l, dl,~t,~ t../,,k ~..~ (Description) .......... [ ........................ Fee .......................... ,- ........... Estimated Cost ..... (to be paid on filing this application) If dwelling, number of dwelliu~ units ............... Nmnber of dwelling units on each floor ................ If garage number of cars ' If business, commercial or m~xed occupancy, specify hature and extent of each type of use ............. r ' pth Dimensions of existing structu es, if any: Front .... Rear .............. De ....... Height ............... Number of Stories ................................................ Dimensions of same structure s~ith alterations or additions: Front ................. Rear .......... Depth ' Iteight Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ....... Height Number of Stories ' Size of lot: Front ~ ' ' Rear Depth Date df Purchase i Name of Former Owner Zone or use district in which premises are situated... ~..-/. ............................ : .......... Does proposed ' " ordi:mnce or regulation: constrt etlon vlolate any zoning law, ........................ Will lot be regraded ........ I..' .................. Will excess fill be removed from premises: Yes No Name of Owner of premises ~ Address Phone No Name of Architect ......... i ................ '.. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buiklings, whether 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 .tefior or corner lot. TATE OF NEW t~RI~,/ . / · ff.. ?.z/_ .~.,-~' .... ~ . . ,~¥-..~.~,~--,u.-~.6.~...:. being duly sworn, deposes and says t e is the applicrmt ...... ~(Namef f mdw~dual s,gnmg contract) >ove nalned. - ~e is the ....................................................................... , agent, corporate officer, etc.) r said owner or owners, and is d(~ y at thonzed to perform or have performed the said work and to m~e and file )plication; flint all statements contained in this application are true to the best of his knowledge and belief; and that the · ork will be performed in the man'er set forth h~ the application filed therewith. worn to before me this ~ . ~ ..... , , . /,'-~-'?~[ . I~ ' (S~gnatureofapphcant,