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Home My WebLink About13154-z FOUM bO. S 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? 1315~ Z Permission is hereby granted to: ....~.~c~,.~.~...... ~-~.~.....~..~ ~ .... ~0..,. ....... ~Sax ......... ~.(~?.. .............. ,o...~.~...r~.~. ...... ~ ......... ~.../.....~ ...... ~.~.~.~ ................ pursuant to application dated .../~../~?.z~...4~-.......(~...~.. ................ , 19.~....~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD ~NSPECTION FOUNDATION (1st), COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined....~.<57.e~...~..~.., 1¢:~/. Pe,,it No../..X../..V..--54.. Y APPLICATION FOR BUILDING PERMIT Received..¢/.~.d....,19& INSTRUCTIONS a. This application must be completely tilled in by Wpewriter 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 necessa~,n~/0e310 (Signature 6f applicant, or name, if a c p ' ) ... ~o: . .~. ~. ./.O~.f. .... .5o,,:O,o/d ............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~.e~.~^ [...e0.~ .4~.~.o.4 .o<: ................................................................. Name of owner of premises .... ~ ?f. ~..{~.~$'.4$OV,q.~{g ................................................ (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... ~.~ 5 ................... Plumber's License No ......................... Electrician's License No ....................... Other Yrade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ....... ........ House Ntimber ~-'~, ~0& .........Street ..................... mm]e; ........................ County Tax Map No. 1000 Section ..... .~..~. ........ Block ...... ! ........... Lot.. Z .~. ........... 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 . ..~. ~.5. ~lJ~.~'.{'7. ..................................................... b. Intended use and occupancy .... .~../'%'4..: ........................................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ..... ~ .... Demolition Other Work fi( .~.~.~ ~ (Description) 4. Estimated Cost · ·: .......................... Fee ...................................... !~ *" (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mix6d occupancy, specify nature and extent of each type of use ..................... 7. D~nensmns of existing structures, ff any: Front ............... Rear ............. Depth ..... Height ............... Number of Stories-. ....................................................... Dimensions of same structure With alterations or additions: Front Rear Depth ................... :... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction:. Front ............... Rear .............. . Depth ... ............ Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... ~ ................... Name of Former Owner ............................. I 1. Zone or use district in which pri~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .P~.. ............................ 13. Will lot be regraded ... 100.. i ............ - ....... Will excess fill be removed from premises: Yes . No 14. Name of Owner of premises .h~-.g. ~-t~tt~t~.~4.$ .... Address .. ~l~¢x~ ~.,1 .? ~.~?.~.].~. Phone No ............... Name of Architect ......... ~ .................. Address ................... Phone No ................ Name of Contractor . ~r, or~!.. ~t~¢t. ~a~t~5.. Address CO.'~.j¢ l~.. ~,$t.4.~ ./d. Phone No. ~.~.~.-,~.t~.O. ..... '~'~"~"~J.: PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockl 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 above named. ~ '(Name of individual signing! contract) He is the ...................... i ................................................................... ! (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ihis 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 manne~ set forth in the application filed therewith. Sworn to before me this ....................... ............ Nota. Public, . ......... , HEt~N K DC] VOE ...... N0rA~IY ~U Il-10, S a e of Ne~v Yor~ (Signature of applicant) N~ 4~0787~, ,qnfloll{ countF T~,:,r~ '~:~,r,~, ~1~ 30, 19,_o2"5--