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Home My WebLink About12828-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl. $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 128~8 Z Permission is hereby granted to: ........ ............... ....... ~....~.~.z~..:~....~:.. ,o ..... Z~..~.~ ........... ~z~& .......... ~.~ .......... ~ .............. ~.....~.. ......... .................................................................... ~ ....... ~ .................. ~,~......~~ ..... ,, ~,,~,,, ,~,.~ ~ ....~.~:~(~.....~..~...~.~....(~~...~ ........ ....................................................................................................................... ~..~ ............ ...... .("~...~. ....... Lot County Tax Map No. 1000 Section ... ,~..~.i~.,, ........ Block No...~.~)',.~-~. .......... ~,,~ont to opp,~o.on ~ated ..... 2~*: ........... /:..~.~... ................ . l~..~on~ a~o~ ~ t~e Building Inspector. Building Inspector Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS _J BUREAU OF ELECTRICITY O0~F4Db(D~ ('~F ]'~)~'~ 85 JOHN STREET, NEW YORK, ~-~ ~.~'~"~" ~. ~"~"~ N 662742 THIS CERTIFIES THAT in the following location; ~ I~,neq~,~ 1st FL ~ 2nd FI. Section Block was exa~dned on ~tO~X' ~'~ ~ ond found to be ln compliance wlth the req~irernents of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS This certificate must not be altered in any manner; return to the office of the Board }f incorrect. Inspectors may be identified by,thei FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803.~.../~ Examined ....... ~ ..... , 19 Received .......... ,19... Ap prove ~:? '$~... '.~. ...... 1 ~? ~ermit No./.<~. ~.'~.~ ./ ·;' ~" Disappr~d a/c ....... ;~. ;.-~]. f .... ~~j ~~4~ (Building Inspector) 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 applican~ agrees to comply with all applk'able,.~ laws, ordinances, building codec, housing code, and regulations, and to admit authorized inspectors on premises ?__~ bu. ildin~4or necessary inspectic~__~~/^l]//].~f),,/J,.~'-v-- (Signatur~nt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect~ eg~neer, general contractor, electrician, plumber or builder. Name of owner of premises [~.~.0~ .~.~. ,~.~.../~.~ .~..~.~.~.{'7..~:..~...~u:~.. ~ .......................... (as on the tax roll or latest deed) ff applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................ '} . . .' .............................. .../. Z .q .' .. . . . . . ...... : ... ~.. - ttouse Number Street ~ Hamlet County Vax Map No. 1000 Section ...O.(.~. ......... Block ...~. .............. Lot..bT ............... 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 ..... .O?..~.. f:.~. 72. ~.W(.,..~. ~.~.tr.~ t .~..e~.. 6&.l~. 0..~fl)...4°.. ~...C.o.-ry..t~.&..ff.s ....... '.. b. Intended use and occupancy .... ~. ?. e.-....w. ~.T ~....Rp.l.~...ff .~.ot.c,. ~.-... ~..~.~T .~'..~.T?.~.. ?....T?.~. ........ Nature of work (check which applicable): New Building .......... Addition .......... Alterati~ . Repair .............. Removal .! ............. Demolition .............. Other Work. i~t4~,~_.: .... /~ f'~ ~ ~.~.~ ~ -> /~m~'~H .~~'- ' . (Description) Estimated CostV' 7; L2~.'..O~..C/. ........ ................................. Fee, .qY.- . ]' .. . . (to be paid on filing this application) 5.If dwelling, number of dwelling units . .............. Number o f dwelling units on each floor ................ If garage, number of cars ........ j ............................................................... 6. If business, !commercial or mixed occ, upancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if ~ny: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ~.. Depth . ..~ .................. .H, eight ...................... Number of Stories ...................... Dimensions of entire new construction: Front ....... ,... Rear ............... Depth . ./.6~. Height ............... 'Nmm:l~t,-of-Stm~i~ .%/;q~ .9-i6.. ~<~...0..~. ..................................... 10. DateofPurchase .Ll:.~.'.ff.'S. ................. Name of Former Owner''- ' ' "f...' .......... ~) Zone or use district in which premisOs are situated../~¢ ............................................... 12. Does proposed construction violate ~ny zoning law, ordinance or regulation: ................................ ~/~_3x Will lot be regfaded ...... ~.. ..... ................. Will excess fill be removed from premises: Yes No Name of Owner of premises ~.b.b.o.~,.~..~.~,p.f~ ....... Address]~'O.~.'g0~..~..~.f..de..o .fe~. Phone No. '7~?. Nam{, of Architect .... ~C~.;.~?.~.ti'~ .~?.e.~.... Address ..... "' ' Phone No w.~g r[*..S .... .'~ Name of Contractor ............ .............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and bock number or descnptmn according to deed, and show street names and indicate whether interior or corner lot. : STATE OF NEW YORK, S ~ COUN7'~ OF .~t ~.~i~. ....... ........... ............ (Name of individual signing contract) above named. ......... being duly sworn, deposes and says that he is the applicant He is the ............................ .......o ficer, ............................ of said owner or owners, and is duly !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 manner ~et forth in the application flied therewith. Sworn to before me this Notary Publi LINDA F. I(OWALSK NOTARY PU[?LIO, State ~f ~o. 52'~S247~1 ~al//ied i~ Suilol~r Co ~o~mLsion Expires March 3rq D 0 0 b