Loading...
HomeMy WebLinkAbout12955-z 1~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) ~ z ~o,, ..... ..~.~.~.~....~ .................... ,,.~.~./ County Tax Map No. 1000 Section ...... ..~...-]....~. ...... Block ....... ~ .......... Lot No ..... ..'~....j ............. pursuant ,o application dated .....~.~...(~..~.C~.....~...1 ....................... , 19.~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Examined..k.V~.~ .~..2M~.'..., 19~l SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . . .~ '¢4,..~., .~...., 19~.~. Permit NO).~..~..~...-~'.'.. Disapproved a/c ..................................... ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .3/..~..~ ........... 19 .~./. 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 B~ilding 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. ......... (Signature of applicant, or name, it a o po ' ) ..& (Mailing a~ldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ApI~IIOVED AS NOTED ............................ . .07..xA .r: ................................................... .A ~ ~' '/'~'~ ,~ ~-~ Name ofowner ofpremises )5~ ~./~/-/ 4 /'Fl RIEF/I~Vfl~. -20/o~:~.'~'~ .',"-Z,'--/~,'," --" 13~ il, 6 ~ .......... ~ ................... . ....... : · .. 1j_t~ :_'~ ....... AT If applicant is a corporation, signature of duly authorized officer. 765-1807 9 AbA TO 4 PM V©P. T~'r (Name and title of corporate officer) Builder's License No .... .,5. ~. {..~.J ............. Plumber's~icenseN°' "iii~ i Electrician s License No. FOLI~C~x^i1~4G 1N?ECT!C)bI%: 1. FOJhlr'A'TION ' Tx^~ RTc~~m~Fq F~ , ,,,~,,~c-~ CONCn~:-r0' 2. R~LJ2" - FRAMING ~ ' - 3. IF~'~ ~' "T~'~N ALI ~ .......c,,. 'r'--~qN.. , SH/4 1._ MEET S~rA ....... qCTRijCTION & ENERGY Other Trade's License No ...................... COr'r'~ '-.I'~T REsPONSI[:LE FOR ~ ~OES~{,~/e; ,. ~oNSTRUCTIO~ ERRORS. 1. Location of land on which proposed work will be done .... l)./.~..t.~.....~..~.~.1.9.t.~.. ~ ...................... ....... .s.¥.q ............. ................... .................. House Number Street Hamlet County Tax Map No. 1000 Section ....... . ]..~. ...... Block Lot .C~.. { 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 ..................................................... b. Intended use and occupanc ......................................... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. Nature of work (check which apphcable): New Bmld~ng .......... Addition .......... Alterat~,~.., ....... Repair .............. Removal .............. Demolition ............. Other Work..-n'-A:~c.4...~. .... (Description) Estimated Cost ...%) ...... Fee ...................................... ~ ~-. (to be paid on filing this application) 5. If' dwelling, number of dwelling Units ....... ~' ....... Number of dwelling units on each floor..It. ............. If garage, numbek of cars .... ,¢/~. ................................................................. 6. If business, commercial or mixe(~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ '~h It rat' dditio Fr Re Dimensions of same structure wi. a e mnsor a ns: ont ................. ar .................. ~, Depth ......... '.. Height . Number of Stories ......... ~ ..... · ' .......... : . / ~01 . [ ~ D~mensions of entire new constr~ct~on: Front ..... ,~',g ....... Rear ..../ ........... Depth ...7..~ .......... Height .... .c/ ......... -Num~ .~.~o...~.... 93, ....................... ;, ............... /~)~ Size of lot: Front ...... /..~.q .( .......... I~hr ....... /..,,?. ........... Depth . ~,~-..o. ................ /1Q~/ Date of Purchase .... ¢.,~g., .) .q.~3 ............. Name of Former Owner .. ~5.,~,.~O.. ~..~.x..o~.].c~. ,. ........ 1 1. I Zone or use district in whicnpr~mises are situated ..................................................... 12. /Does proposed eonstructton vmlgte any zoning law, ordinance or regulabon: ............................. 13. ]Will lot be regraded L/(--2. .................. Will ex%ess fill be removed from premises: Yes 14./Name of Owner of premises . J~ AP.~.S....w..~ ...... Address .~ngtr*Y.i~t4q{~ .~.~ .... Phone No..2 6.Yf.:'.2.'7.ct .~... ~ Name of Architect .......... J ................. Address ................... Phone No ................ Name of Contractor ......... ................. Address ................... Phone No ................ buildings, whe-dre-F~i~ting or proposed, and, indicate all set-back dimensions from dumber or description according to deed, and show street names and indicate whether / STATE OF NEW YORK, ' COUNTY OF ................. ~O-~...~.~ i being duly sworn, deposes and says that he is the applicant (Nam6 of individual sig~ing contract) above named. He is the ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that ~1 statements conta~ed ~ this application are true to the best of his knowledge ~d belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ..... HELEN K. DE VOE NOTARY PUBt. IC, State of New ¥orjj No 4707878 8t~flolk County Term Ex011es Marc¢) 30, 19~5 (Signature of applicant)