The URL can be used to link to this page

Home My WebLink About15602-z lrO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15602, Z Permms~on ~s hereby granted to: ..L..o...~...o......~.. ~....~......~...~.: .... .~~.~....~..~:~.: ...... u..~..'l..t ..... .................................................................................................. at premises located at .t.~....~...~..-~.......~.~....~..~..: ..... ~.~...~.... ................... County Tax Map No 1000 Section ....... Il.'~. . B~ock ...... /..(. ........... Lot No ...... ~.6.'1:. ....... pursuant to application dated . ..~,).~.~...J...'~.. , 19 ~)~, and approved by the Budding Inspector. Fee ,.1..~.....:.. ~ Building Inspector Rev 6/30/80 FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N Y. 11971 TEL. 765-1803 Recezved ........... ,19.. D~sapproved a/c (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date [fi~-~. //7 ,19 ff..r INSTRUCTIONS a Tins application must be completely filled in by typewriter or in Ink and submitted to the Building Inspector, w~th sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing locatmn of lot and of buddings on premises, relatlonsinp to adjmmng premises or public streel or areas, and g~vmg a detmled descnphon of layout of property must be drawn on the dmgmm which is part of this appl cation. c The work covered by fins apphcahon may not be commenced before ~ssuance of Building Permit d Upon approval of thls application, the Building Inspector will ~ssued a Budding Permit to the applicant Such perml shall be kept on the premises available for inspection throughout the work e. No budding shall be occupied or used m whole or in part for any purpose whatever unt~a Certificate of Occupanc shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the msuance of a Bmldlng Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buddings, additions or alterahons, or for removal or demohbon, as hereto describer The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and t, admit authorized inspectors on premises and m bufldmg for necess~mspectmns. ,, /~ : (Signature of apphc~fn~/or nagde, ff a corporation) C~(,tal,~t~:f~ address or app :l_cant) State whether apphcant is owner, lessee, agent, architect, engme~/~lene'r~l~contractor, electnman, plumber or builder /CO .............. Name of owner of premlses C~t~ '-~ ~ C L_~ .... (as on the tax roll or latest deed) If appbcant ~s a corporation, signature of duly authorized officer (Name and htle of corporate officer) Builder's License No Plumber's L~cense No Electrician's License No Other Trade's L~cense No Location of land on which proposed work will be done House Number Street County Tax Map No I000 Section //~7/ ............. Hamlet f?. .. 2 Subdtv~s~on, Fded Map No Lot (Name) State ex~st~ng use and occupancy of premises and intended.use and occu~oa~cy of proposed constructmn a Existing use and occup~'~ ~~-~.~ C ) ~X~. ~. ~_~ .... b lntended use and occupancy -~ ~ ~ £ ['22~ ~ I <~ ....... ,ature of work (check which apphcable) New Braiding Addition Alteration Repair ... Removal ....... Demoht~on .. Other Work. .. (Description) 4 Estimated Cost .~/./)./ c).~9 ~,. ......... Fee ................................ (to be pad on fihng th~s apphcat~on) 5 If dwelhng, number of dwelhng umts. ff/~. .. Number of dwelhng units on each floor ..~/~ .... If garage, number of c~s . 6 If business, commercml or m~xed occupancy, specify nature and extent of eac~ type of use ~/~7 F/~ ........ t t 7. D~mens~onsofemst~ngstmctures,~fany Front ~ . . . Rear ~. ~... Depth ~ ...... Height lff t Number of Stones . ] . D~ens~ons of same structure w~th alterations or additions Front ~ ~ Rear ~ .~.. Dep~ ~ . . He~t ./ .~ . Number of Stones . ~ 8. D~mensmnsofent~renewconstmct~on Front ~ .. Rear...~ ...... Depth .~.. Height ~ ~ ~ ~ Number of Stones 9 S~ze of lot Front ~ff ~ . . Re~ ~ ....... Deoth, ~ ~ ...... 10 Date of Purchase . /~ ~-~ Name of ~o~er Owner ~K~.q~...~.~P~ .' 11 Zone or use d~stnct m which premises are s~tuated.. ~ F~9 Z ~ .. ~q V~f ............... 12 Does proposed constructmn vmlate any zomng law, ordinance or regulation .. ~ ................. 13 5flllot~regrade~ .~Q ;.~..;.,; "I Wfllex~f~b~removedfromprem~ses ~s 14. ~me o~ owner orprem~ses ~ ~ 0 ~ ~ ~ ~ ~ddress . P/~e. ~.~. Phone No ~ ~ ~.~ Nme of Architect , ~ ........... Address .............. Phone No ........ Nme of Contractor .~ ~'r~ ~af.~ddress ~ ~~Phone No ~ [: ~ ~. 15. Is th~s property located w~th~nl00 feet o~ a t~dal~d~'~e~ ..... No ~ ~ Zf yes, Southold To~ Trustees Permit may be required. PLOT DIAG~ Locate clearly and chstlnctly al! buildings, whether ex~stlng or proposed, and ~ndlcate all set-back dimensions from property hnes. Gwe street and block number or description according to deed, and show street names and indicate whether interior or comer lot STATE OF NEW ~O,R,K, . COUNTY OF. .... S.S .. .,~'c-)t93S~.~, ~ .~O~/M~ . be~ng duly sworn, deposes and says that he ~s the apphcant (Name of ~nd~v~duaI s~g~mg contract) above rimed He ~s the ......... ~ ~ ~ ~ - Z ~' ~ ~- ~ (Contractor, agent, co. orate officer, etc ) of smd owner or ownem, ~d ~s duly authored to perform or have perfo~ed the said work and to m~e ~d file th~s apphcatmn, that all statements con.ed m th~s apphcatmn are true to the best of ~s ~owledge ~d behef, and that the work w~l be perfomed m the m~ner set for~ m the apphcat~on filed therewith Sworn to before me th~s ....... ~..~ ...... day of ~~.. , 19.~ ~ota~ Pubhc, . ..... ~.~~ . . Count~ ~' ~ ~ (S~gnature of apphc~t) OUNDATION (1st) OUNDATION (2nd) OUG~ FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: