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Home My WebLink About15312-z l~O~ NO. ~ TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15312 Z Permission is hereby granted to: ...~,.,a~~..~..~.~ ..... ...~.~..~....!~.~ ............................................ ..... ~~~..,.~***.~.......!.,L~.~.~.,r~ ,o .~~...~....~..~~..~...v....~...~.......~~ - ~_ ,, ~ ................... .~,~......~........... .................. ~...~ .......... ..+~....... .................. .~ ................................. atv'~ (° C~premises located at ....."~......J. .......... ...'~..~.~ .......................... '~a.,~ ~ .......... County Tax Map No, 1000 Section ....... ,.C~,,~ LJ Block ...... ,~.~, .......Lot No. ,. pursuant to application dated .... ~.~....~...~...~... ........ , 19.,.~...~., and approved by the Building Inspector. ~.~ ,.~.~.~...~. Building Inspector Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~ th~ electrical e~ulp~e~ ~ ~erlbed ~e~nd ~r~d~ b~t~li~L~he abo~e application n~mber in the prorates of [MX11UII~TE$ IECIP?~TACLES SWITCHES~.INCANDESCE"T ,~LJuXo~EUScReBNS~ ~v~¥ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT I NO. OF I S )FHER APPARATUS: 1-G.F.C.I. [] 2.d ~'t. Outside .~ection Block Lot EXHAUST FANS DIMMERS A W O A W. G NO OF NEUTRALS A, W G, OF CC. COND_ NO. OF HI-LEG OF HI-LEG OF NEUTRAL (S~__mg_i_~.~!) This certificate covers oomp].i~nce at the date of inspection only. Becau~e of unusual environments it is advisable to h~ve f~equent test/~nd or repairs made by a qualified Paul Burns 275 Tova] Harbor Lane ~uthold, N.Y. 11~I ~c. 28~E GENERAL ~AGER 7his certificate must not be altered in any manner; return to the office of the Board COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED N ANY MANNER. F1ELD INSL~ECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL coMMENTS: "IMMEDIATELY" ENCLOSE POOL TO CODE UPON COMPLETION BEFORE "WATER" FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971., TEL.: 765-1803 Approved .~'. ~s'r~,~-~.-'..~.~., 19~.~ Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Roco±ved ........... ,39... E6, /o Date ................... 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 street: 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 permil shall be kept on the plemises available for inspec[ion 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 o~ 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 te admit authorized inspectors on premises and in building for necessary insp~e~tio . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Name of owner of premises .............. .~. ..... ....... i ........................ (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 ..... ~ ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ ................................................. . . y& .................... ./ }iouse Number "~ire7 ......................... Hamlet ~ ................. County Vax Map No. 1000 Section .... ~.~. ....... Block ...... ~ ........ Lot ...... '~.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exist ng use and occupancy t~tY~~ f/i CZ.~-.~- f)cejr . ...................... 7' ........... ~'~.. ~'~!~ vy .... i ............ b. lntended use and occupancy h~Lt.~-' 9~.~t/dO~ ~~!~*:: ........... Nature of work (check which apphcable): New Repair .............. Removal ........ ' Estimated Cost ...... i ....... Building ..... ~' ,.. Addition .......... Alteration ...... .... Demolition .............. O t h er Work bff/g'Yd...~..iV. Z ~k:X- (Description) (to be paid on filing this application) 5. If dwelling, number of dwellin units ............. Number of dwelling units on each floor ................ ~ If garage, number of cars .... : .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7 Dim ' f ' 'ngstmcturb 'fany F . Rear Depth .............. Height Nmgber of Stories ' Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ................... :... Height .............. : ....... Number of Stories ...................... 8 Diruensions of entire new const.ruchon: Front Rear Depth Height ............... Number of Stories ............... . ......................................... 9. Size oflot: Front .......... i ............ Rear ........... ' ........... Depth .................... .. 10. Date 0f Purchase .......... !' ........ Name of Fonner Owner ..... ; 11. Zone Or use district in which p~,emises are situated ................................................. 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ............ [ 3. Will lot be regraded ........ ~ .................... Will eX6~ss' fill be removed from premises: Yes NO 14. Name of Owner of premises . .i .................. Address ................... Phone No ................ Name of Architect ......... ; .................. Address ................... Phone No ................ Name of Contractor ........ ; .................. Address ................... Phone No...~.~ ........... L5. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No .~f... *If yes, Southold Town Trustees Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from *roperty lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether nterior or corner lot. ¢TATE OF NEW YORK, S.S .~OUNTY OF ................. ............................ ~ ..................... beC'nfl duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ibove named. lc is the ' , (Contractor, agent, corporate officer, etc.) ff said owner or owners, and is duly authorized to peri'oran or have performed the said work and to make and file this ~pplication; that all statements conitained in this application are true to the best of his knowledge and belief; and tha.t the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this i ~otary Public ................ County i (Signature of applicant) Oz ZO I rn>