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Home My WebLink About13140-z FOB.BE NO. 9 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) N? ~3140 Z Permission is hereby granted to:/v_~. ............. ~.~....z~'..,:,~ ' ................ ........ ~.~..~:.:......~:.~_~....~:.¥~~ ....... to ...... .~. ~.~.~-~-ZE.~.c.~-TT...........~.. ,~:~.~. ................................................................................. at premises [ocoted ot .......~...~'..~...~ .............. ..~-.....~T... ........................................ ~ ............................ ....................................................................................................... ...... County Tox Mop No. 1000 Section ...... /.J...~.. ........ Block ....Z.~.. ......... Lot No..~../...~2. ........ ,~u,~uo,,t to opp,co,on dot~ ..... Z~..47..~ .......... Z...~... ............ , Building Inspector. Fee $. J..~.. ............. Rev. 6/30/80 FIELD INSPeCTiON DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ~OBGH FRAME & ,.. PLUMBING INSULATION PER N. Y. '' ~' STATE ENERGY FINAL ADDITIONAL COMMENTS: ' ~q FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ . TEL.: 765-1802 amined. Approved. ,.~.e~.~....( .~.., 19~'.~.SfPermit No ZJ.f..C-f-. C'''-~) '~ Disapproved a/c .... ~-. · · · · ·. · · · .~-"'--'--'"--'-. ......... '...),~-) · · · ./, (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan stxowing 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 issue a Building Pen-nit 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 buildings for necessary inspections. (Signature of applicant, or name, if a cc~¥oration) ^ I (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor¢ ~lectrician, plumber or builder. Name of owner of premises O~J~/"' ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder'} License No ......... ~.~.~-'~ Plumber s License No ......... '; ......... ~. · · · Electrician's License No ........... ~.~.: ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ,3 ...... .¢ .. House Number Street Hamlet ' C;[~nty Tax Map No. 1000 Section .... [ {.~ .......... Block ... [.O. ............ Lot .... ~. ~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .............................................. b. Intended use and occupancy ..... L~ .............................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '-- (Description) 4. Estimated Cost ..... ~-~ ............................ Fee ............................. (to be paid on filing this application) 5 If dwelling, number of dwelling tinits ............... Number of dwelling units on each floor ............... If garage, number of cars ..... 1 .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structure~,, if any: Front ............... Rear .............. Depth .............. Iq.eight ............... Number of Stories '. ...................................................... ' ' ' ' Front Rear Dimensions of same structure wi:th alteratmns or add,trend: .................................. Number of Stories Depth .................... ~.. Height ........................................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Num[ber of Stories ...................................................... 9 Size of lot: Front ~ Rear .... Depth ..................... 10. Date of Purchase ........... ! .................. Name of Former Owner ............................ 11.' Zone or use district in which premises are situated .................................................... 12. Does proposed construction vic!ate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No ' Phone No 14. Name of Owner of premises ..................... Address ................................... Name of Architect . ' ........... ..... : ' ' 'i .....~ .......... Address ... Phonephone No.?.~. 9. x ~).¢.~'..Nc .......... ~.... Name of Contractor .~~.. ~... ~ .... Address .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!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 ' being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named. He is the .................... ~ .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is rely authorized to perform or have performed the said work and to make and file this application; 'that all statements contained,in this application are true to the best of his knowledge and belief; and that the work will be performed in the manfier set forth in the application filed therewith· Swo:m to before me this :~ ........ . 'x-rc da ......... ,19 Y Notary Public, ........ , .-er.~r; .--'. ,!.: ~.: .... County . .~....~.~ ~ ~' '"'""'~ HELEN K, DE VOE I ~", NOTARY PUBLIC, State of Ne~ York ...... ~;~'' ° "' ' ' ° ° ' ',, No, 4707878, Sufl0I~ C0udty ..... (Signat~ of applicant) ' t~r*n Expires March 30, 1~'3