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Home My WebLink About15021-z ]FORM. ~O. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15021 Z Dote / Permission is hereby granted to: .~ ........ ~ ....... %.~. ......................... ~.. .....~.~.~...~...~...q.. ................................................. ..~.~....~.:~.:.....I.L~.~.~ ........ at premises located at ...... ~ ...................................................................... County Tax Map NOl ]000 Section ...... ,.0,,..,~,.~,~. ...... J~Jock ........ ,,~,..! ........ Lot No ..... ..C~. ................ pursuant to application doted ..... ..~. ~....~....~ ....................... , 19.~..~., and approved by the / Building Inspector. Building Inspector Rev. 6/30/80 FIELD INS[JECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD ' BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1803 BLDG. DEPT. , TOWN OF SOUTHOLD Examined ...~d~4,~ ~.~ ..... 19 ~.~. Approved ....~.~ .~.'7..., 19~.~. Permit No./~.'~..~...~ Disapproved a/c ..................... i ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19. a. ~l~is, .~pp!i?tiqn~,%t&e 9prnp~i~i~ll~t~l tyF~l~r~9~ji%j%$ fqtd~ubmitted to the Building Inspector, with b. Plof plan Sho~ing rotation of lrg,~l, oj~i~,laa l)[em~ses, re~auonsnip to aojoining premises or pumic sire or areas, and giving k detailed descripfi~l~lat~t ftffi-~/l/~Wdrawn on t~e diagram which is pa. of th~s ap~ cation. c. The work covered by this appl~'.C~, i~va~[~~,n~, before issuance of Building Permit. d. Upon approval of this applicat~on,~t'h%~ltflff~l~t~ct~l~l issued a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection th, roughou[,~he wbrk. e. No building shall be occupied or used in whole ~'r in'part' for afiy purpose whatever until ~ Certificate of Occupan sha ~ . to themBuilding Department,for the issuance of a Bulld!ng Permtt puts t Buil~j~e~~'of Southgld, Suffolk Cq~3~ty, New York, and other apphcable Laws, Ordinances Re~fl~r~e~h~l%L~(l~t~uildh~gs, ~/dditiorts or,:alte{a¢9~ns, .¢r for removal or demolition, as l~erein describe The applicant agrees to comply with all applid§bl~ la~s,'B~'(~]nan~ces, l~i~'~ding Code housing code, and regulations, and admit authorized inspectors on premises and in building for necessa~ry inspections. . ..~.. (Signature of applicant, or name, if a corporation) · ~.~)~... ?~.~ ~. 7.%q ...................... [ma±J-zng aa~ress o,r. app~.cantj State whether applicant is owner, lessee, agent, architecb engineer, general contractor, electricmn, plumber or builde Name of owner of pre,nises ko.o.q .¢.h.vr.e. ~-~o. etv. p...m, en.L..C.¢.cpoco&,.c.h ........ · (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...q~(.O.."~. ............... Plumber's License No ......................... Electrician's License No ......... , .............. Other T,'ade's License No ...................... 1. Location of land on which proposed work.will be done ................................................ ~.~/oo ~,~ ~d ' House Number Street Hamlet / ? County Tax Map No. 1000 Section .................. Block .................. Lot .................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use ans[,?,ccupancy of proposed ~:onstruet~on / ~ . a. Existing use and occupancy .......................................... b. Intended use and occupancy · · . ................ 3. Nature of work (check which applicable): New Building .. Addition ' ' ' ' Alteration Repair Removal ' ' Demolition ' ' . J.. Other Work '. : ,, '~' c ~ ~-~ ~,' (Description) 4. Estimated Cost ................................... ~ . . (to be paid on ~tllng thts application) 5 If dwelling number of dwelling units Number of dwelling unity on each floor , If garage number of cars ' ' . ' ' t Of yp~ '~ 'each t of use . ' .'. 6. If business, commercial or rmxed occupancy, specify nature and exten .................. 7 Dimensions of existing structures, if any: Front Rear ' Depth Height Number of Stories '~ ~ Dim i fp 'th ' " : dditi Fr J..'Rem-..J.. ens OhS o amc structure wi alterahons or a ons: ont .'" Depth'... Height~ Number of Stories 8 Dimensions of entire new construction: Front Rear Depth Height ............... Number of Stories ........... ; ................ i ......................... 9. Sizeoflot: Front ...................... Rear ...................... Depth .................... I0 Date of Purchase Name of Former Owner 11 Zone or use dish ..... 'mt in which prennses are mtuated 12. Does proposed construction violate any zoning law~ ordinance or regulafion: .... i ....................... 13. Will lot be regradqd .................... i ....... Will'" excess fill he r~m~ved from nremises: Yes No 14. Nmne of Owner o~prer~i~e~.r.~f.~)~.0¢.l~.~.~.~..~.~ddress~. ~f]~<~ Name of Architect .......... Address ................... Phone No ................ Nmne of Contractor .~C).O. ~-~'~..~CD .. Address '..-:~tA-~JCt~..~ ;... Phone No:-].(o~...~.'.7 i5. Is this property located withinl;00 feet of a tidal wetland? * Yea .... No ...... · If yes, Southoid Town Trustees Permit may be required. PLOT DIAGRAM : Locate clearly and distinctly all buildings, whether exisfing 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 intimate whether interior or corner lot. eecaccLc_L q o( bo+h Uo_-I a If ooPi~r tubing is used , for water distributing system; piping shall be of ty~ K or L only OCCUPANCY OR USE IS LEAD CONTENT ~EFORE CERTIR TE STATE OF NEW YORK, S S COUNTY OF ' (Name of individual signing contract) above named. too ~O'r~ BUILDING OEp~T~T AT 2; ~OtjG~'t [:RA~N~ ~ being duly sworn, depolses and says that he is the applicant He is the ........................................................... ; ............................ (Contractor, agent, corporate officer, etc.)1 of said owner or owners, and is duly authorized to perform or have performed the ghid work and to make and file this application; that all statements contained in this application are true to the best of hi~ knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... i.~ ~. .......... day of..~=. ,, ........ , :C.g. Notary Pubhc, . ~ fi~ ~//~ · lY PUDLIC, SMe d New Ye~ lerm ~p~ ~rch 30, I~t ~g ature ofapphcant)