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Home My WebLink About14980-zTOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14980 Permission is hereb/granted to: ........ ~.-'~.....~...,..~,,.~. ~.~.~.~... ..~.~.....~.c3 ............................................ ro ..... (3:::~. l~,,x..'5TL-. ~.~.C.q'~... ........ :~,,~ ..b~....c2.~.. ................................................................... County Tax Map No. 1000 Section ...... I.~.~... Block ...~..,,~. ...... Lot No..~.../...~'. ....... pursuant to application dated ........ Jl~';j.~J~--~......~. ..................., 1~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD ~I~Pi~i.[ON 'DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2 · ROUGH FRAME & __ PLUMBING -- INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 Examined .~.[~J~.. 1,7., .... 19 ~ Approved ~lJt',&~.. J,.~....., 19 ~.. Permit No. I .~.~. · .~. · .~ Disapproved a/c ............... ~, ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT o ~ou~ot~ Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the ,B,ulldin? Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t6 schedule b. Plot plah showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giging a detailed description of layout of.p~opert, y must be 'dra'~'n on the ~iagL,am 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 leept onthe 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 ~ Certificate of Occupancy ~ ~ha~ll ha~e been granted by the Building Inspector. APPLICATIgN IS HEREBY MADE to the Buildmg Department for the ~ssuan e of a Buil(ting Permit pursuant to the B'uilding Zone Okdinance ot' the Tdwn 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 inspectic~n~4s' - ............. . , ., (Signatur~ ~l~cant, or name, if a~- ~----~..P ' ) ......... ~ii~'~33~ of applicant) '' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................... Name of owner of premises .x~..A~...~r~. · .~.'. ~...{~..~5~.0~. ................................................ (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 ......................... Ele,ctrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~.~.<.U..~..~.....{?~....~,e'...~. ?y.C.~.~.'~. ............. ........ ($Y.u~. I_~ .................................. ...... ......... . House Number Street Hamlet County Tax Map No. 1000 Section ~...t.0. .~.. Block ~ .... 3 ....... Lot ...... ~.~' .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occ~upan~y of proposed construction: a. Existing use and occupancy .... ~..~.t~)~'~. · ./~.. ........... '(..'.". f..'~:~:'. .......................... b. Intended use and occupancy . . .~..~ .... t~. · · ~ .................................... ; 3. Nature of work (check which applicable): New Building .......... Addition... ! ....... Alteration .......... Repair .............. Removal .............. Demolition ............... Other Work... ~.~/~.~'-. .... i (Description) 4. Estimated Cost.. ~ ~,,~..O. Fee .~ ~ (to be phid on filing this application) 5. If dwelling, number of dwelling units ~ Number of dwelling units]on each floor. If garage n~ber of cars ~ 6. If business, commercial or mixed oceupancy, specffy nature and extent of each typ~ of use .~ ................... 7. Dimensions of existing structures, if any: Front ............... Rear ........ ~ ...... Depth ............... Height Number of Stories D~ensions of same structure with alterations or'additions: Front ............. i .... Rear .................. Dep~ ...................... Height ...................... Number of Sto~es ...................... 8. Dimensions of entire new construction: Front ............... Rear ......... ~ ...... Depth ............... Height ~..~ ....... Number of Stories .~. ~ .............. , ........................ - 9 Size of lot: Front ~ Rear Depth N f Fo er O 10 Date of Purchase . ~ amc o m wner ............. 11. Zone or use district in which premises are situated... R.~ I P~I~ ........ ~ ........................... 12. Does proposed construction violate any zoning law, ordinance or re~lation: . ~.] ...................... 13. Will lot be regraded ...~.~... ................... ~ Will excess fill be removed~ from premises: Yes 14. Nmne of Owner of premises . ~. ~ ~$P~ddress ~.~ .~ ..... ~... Phone No. ~ ~ ~7~...~.. Nme of Architect ........................... Address ................ ~ .. Phone No ................ N~e of Contractor Address ~ Phone No 15. Is thSs property located w~th~n i*00 feet of a t~dal wetland? ~ ~es ..... No ..... * If yes, Southold To~ Trustees Permit maybe required. PLOT DIAGRAM Locate cle~ly ~d distinctly ~1 bufld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions frnm prope~y ~nes. Give street and block number or desc~pti~ according to deed, ~d ~ street nines and indicate whether : a7_ - STATE OF NEW YORK, S.S I COUNTY OF ................. i ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) , , above named. ,' V '. '" c v, . .,,. He is the .................................................................... (Contractor, agent, corporate officer etc.) of said owner 0[ owners, and is duly .authorized to perform or have performed the said work and to make and file this application; that' all sftitem~/~fs contai~ned in this applicMiog are tru~ to the best of his~knowledge and belief; and that the work will be performed m the manner se{ forth m the apphcat~on filed therewith. Sworn to before m~,thi~ ..... , ......... .~. ........ day of.. ~ .......... , 19.~. .., Notary Public, .~.... ~.-.. ~..~./..~.. ..... County ..~..... ~~ I/ (Signature of applicant)