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Home My WebLink About15830-zOUNDATION (1st) OUNDATION ( 2nd ) OUGH FRAME & FLUMBING U;SULATION FER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FOI~I~ NO. 0 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_o 15830,Z Permission is hereby gronted to: .~..~.....~,....~..: .... ..~.~x.......~.~..~ .......................................... ..~ ~s.. L>. 1l .... ~ ................... ~., ........ .fl...~.~ .... ..~. ~....~...~,~.....~,~. .............. ~: ................................... ~....~.~....., ............... at premises located at ....~....~....~.. ....... ¢~....~......~......~ ....... ..~...~.....~~ .............. County Tax Map No. 1000 Section ........ ~../...~.. ....... Block ..... ...C~......~... ...... Lot No ..... .~..L~. ............ pursuant to application dated ...~.~.../...~ .................. , 19.~...~.., and approved by the Building Inspector. Rev. 6/30/80 , ,~ ~ 'FORM NOi 1 .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 .hr~ o,,4g..~.~.., 19~ .~. Examined. Approved . .')Oq.o~,g..;~J.., 19 ~.7. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 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. -, .. ~.~.~..,X... ~ .~o./~m~-~r~.,../,~..c..,. (Signature of applicant, or name, if a corporation) .. mz..,.. (Mailing address of app~cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·. ~.~r_... c'Z.o.~.'F-~c.'v.er~ .... / ..... .~..~/.c. ~-.-.-~ ..................................... N~wner offs .... /~'~_' ' ' ' ' '~" ~~e~ c'l~e'd' ......................... x,~,-/,,/(Name ang title~f corporate officer) - Builder's License No .... /,-~/. ~. ~...~. ~." ........ Plmnber's License No ......................... Electrician's License No..?. 7 ./. g ............ Other Trade's License No ...................... 1. Location of land on which proposed work will be done...: .............................................. 3 ~ .: .o~. :c¢¢..~..~z~...o-7:... //z/..e-~... ttouse Number Street Hamlet County Tax Map No. 1~00 Section .... /../J .......... Block ........ ..~.. ...... Lot .... .~..~ ........... 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 .. ,ff.././O...d~.~ ~--...../T-_-_-_-_-_-_-_-2~./~,/.~..~ .,~-e2~,('g)~../(-f.(..~" ......-,tV-/ ....... I'''; ......... b. Intended use and occupancy . ~3T.//k;' .~..~'7.... t~>a2'e~/~/I/... ~"-ff/~c~'M~..~.~-.../.'..g_ ~. ~t~ ....... 3. Nature of work (check which applicable): New Building ' Addition i Alteration ~... Repair .............. Removal .............. Demolition ........... .... Other Work ............... 4. Estimated Cost ~ ....................... Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ~ .......... Number of dwelling unit,k on each floor .... ~ ............ If garage, number of cars ............................ ' 6. If business, commercial or mixed occupancy, specify natu[e and extent of each typ~ of use ....... ~ ....... 7. Dimensions of exist)ng structures, ifany: Front. ~..O ... Rear .....'~.. ....... Depth ....~r. 7 . Dimensions of sanle structure with alterations or additions' Front .~ O . R~ar "~& } ' ' ' 8. Dimensions of entire new construction: Front ............... Rear ........ ....... Depth ............... Height ............... Number of Stories ........... ' 10. Date of Purchase ............................. Name of Former Owner .' ............................ 11. Zone or use district in which premises are situated ......................... : ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .. !..,~-:.~.. 13. Will lot be regraded ..... .ff~--~ ................. Will excess fill be removed from premises: Yes fp ' 14. Name of Owner o remises .................... Address .......... I . 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. 140~ fibove named. · · ' -'s ............ being duly sworn, depo,es and says that he is the applicant ~ldual signing contract) . , (Contractor, agent, corporate officer(etc.) of said owner or owners, and is duly authorized to perform or have performed the s~'~wort~ anfl.,to/~nake and file this application; that all statements contained in this application are true to the best of hi~(kn~)~le~dgda~d/~elief; and that the work will be performed in the manner set forth in the application filed therewith. ~ [) Ill Itl I./ I]. _ Sworn to before me this Notary Public, ~,~,~....~.'...~..~...~...~.. ..... C°unty ~b~/ ~ ~atlg ~ ~ ~,.~ ~~iS~ture of a~¢lican*~ -~-~ OCCUPANCY OR ~o~ ~. ~_ ~,~ ~t~ USE IS UN~WFUL ?~,_.~o~.,. Wi~OUT CERTIFICATE ~*c~& =~;~ ~. ~ ~ ~. /. ~, L, C~R~/~/~ FOUNDATION TWO REQUIRED FOR POURED CONCRETE ROUG~ FRAMING & PLUMBING 3. INSULA rl[)r ~ 4 FINAL C, ~e~STRUCTION MUST FI ~ d~nbu~n~ piping "'hal/be % ,/ /2