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Home My WebLink About14948-z ~0~ NO, ~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Permission is hereb/granted to: to at premi o q .......... Lo, No..~..,..I .......... by the Rev. 6/30/80 ";" '0''-; FIELD INSFECTION FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE tiDATE It COMME,UTS FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined....~.J,,l~t,~ .'l .., 19 .~.~. Approved.....~ &~-'.L~ ."~.., 19~.~. 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 ~t 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 inspectom on premises and in building for necessary insp_ecations. / / , } (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ........... ............................................................................ Nasne of owner of premises ... ~.~"/r4~.~....~...~. ~7.b/.~'. ~.,~ .... (/~..'.g~. 4¥.~..~/...~.~. ~.) ~'.r~/~...~. ) ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) -¢uil~%eras License~No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which propo{ed work will be done ................................................... .. ......... .............. ...... ......... House Number Street Hamlet County Tax Map No. 1000 Section .... ."~.. ¥ ........... 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 ..... .~...~...,~..~..~..g.. ~ttl/~lE b. Intended use and occupancy .. ~'~../~. $O ~ t~/.. ..~..t'.t~..~Z ~ ~ .~4./~1~.~ .......... pplicable): New Building .......... 'Addition .... .~'..... Alteration ......... ~vai .............. Demolition .............. Other Work .............. (Description) ,a ......................... Fee .................................... (to be paid on filing this application) s - ni · ngrnumber of dwellin units ............... Number o we ng units on each floor ................ If garage number of cars ' ~ 6. If business, commercial or mix:ed occupancy, specify nature and extent of each type of use ..... ~ ....... ., ....... 7. Dim6nsions of e~xjsting strhctuies, if any: Front ..... ./~..,.t. .... Rear ... 2../.~....~... Depth'i..-.~.. ~.: ....... Height ~..~!..~ ......... Nffmber of Stoiles ...... / ....................................... . ......... Dnmenslons ofsamo structure w~th alterations or addmons Front .... o,~. ......... Rear ... fl.R. ........... Depth .................. ,... Height .................... Number of toiles ................... ..... ~. ...... Rear ..... /~. ....... Depth ....... 8. Dimensions of entire new construction: Front ' H~ight /~.,_~ , ~' t Number of Stories ....... [ .......................... 9. Size of lot: Front .... .~.d~.,.t~;~. ........... Rear ....... /.oq..~.,?..~. ..... Depth .. f0. Date of Purchase ..... ~:././. '..~..'Z. ............. Name of Former Owner . ~.~.~.~. ~q..~. 11. Zone or use district in which ~remises are situated ...... t~',~/.D~..~.TT.,~. .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation ..... ~.t? ........... 13. Will lot be regraded ....... [....~.~. ............. Will exce~sfill be removed from premises: ;Y. es A/~. (~ 14. Name of Owner of premises .,~.d*C'/h/.~./~./J~. Address/.~.~g~q.~.g.~ ~/~t~,~ Phone No.~.'./~. ~../t/.... Name of Architect ........ ~..'-'W. ................ Address ..... '~. ............ ,t-,-o ~. Phone No ........ : ......... Name of Contractor,,,o.~t~/~.~.~.,~.fl.~t~.gt.~.~q~f~s.s~ ................... Phone No..~.~.~.. ?..~..~.~4.. 15. is th±s property'-~'t~h'cI ~'fflll'~t.'~'~"~6t~"~t"'~"'t~'dal wet,_and? '~ Yes .... No ~ If yes, $outhoqd Town Trustees Perm±t may be requ±red. i · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, 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. STATE OF NEW'WOR,K,,r" t. ,, ,, COI.]NTY OF..~;,~.,~.~..~. · a,a . -- · . lc{ ~..~,~.~.' .... .~. I../7'!~.. J/~...~.. .......... being duly'~worn, deposes and says that he is the applicant (Name of individual signing contract) above named. ! e 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 this application; that all statements co6tained in this application are true to the best of his knowledge,and belief; and that the' work will be performed in the manner set forth in the application filed therewith. Sworn to before me~is [ Notary Public/i[~~. County ~~ ..~~