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Home My WebLink About15054-z I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDllqG P ERt,.iiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15054 Z Permission is hereby gronted to: ...... .... ..... ......................................... ...... ~.~.~ .~..%~**~...-~.~....:~***..:. .............. .... (.~O.~.,~.,Y. cz...~.~t.'.,, ~ ~ ~ ~,~*~ ~ . ....... ~ .................... ~~...,.~~ .............................................................. ...... ~.~.,..L~......~~ ...... ~.~.~.~ ~....~,-~ at premises I~ated at ~ ~ , County Tax Map No. 1000 Section ...~.L...~. ........... Block ....C~..C~, ........ Lot No. ,.~(~.'~,¢~.. ........ pursuant to application dated .... /~L~--~......L~. ........................19C~_.~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIEL. D IN~SPECTION CoMMS~i'~ FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y, 11971 TEL.: 765-1803 Received ........... ,19, · · Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................. 19 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspect&, 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..~he 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 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 p~rsuant 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 her~n 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 inspections, r ...... (Signature of applicant, 6r name, if a corporatiqn) ·/~..7. J. '.z'... ~ ./?.~...,.F~/..~./.~. ~'.~. ..... f/.~7 ~-.~ .... (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. L'5.. ~j .~. rp~.~..z,. ~,~../..~.~.v./. 9..~- ........................... Name of owner of premises ..... .~-.'.~.'. · · D~). ~.~.' ~). ~.~'~ ~. ......................... ;7.' .................. (as on the tax roll or latest deed) If applicant is a corporation, signature o~f duly..~u..tgorized officer. ....... ................ .............. (Name and title of corporate officer)/ Builder's License No ......... /> Plumber's License No ......................... Electrician's License No ....................... ~/~ Other Trade's License No ...................... · work will be done' 1. Location of land on which proposed [one ...................................... House Number Street Hamlet County Tax Map No. I000 Section .../~D ......... 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 ......... ~.~.~ ~..~.-. :.. ., ......... , .......... .... ~ ~ '-~/ t~¢, ~ ~J~*~ ,, ~ ................ /.. U. Intended use and occupancy ......... ........ .~~~'-~ .................. ~:~p~ir · . ~ .......... ' 'i~lXlikxl'~~,,~ ~f Bgval .............. Demolition .............. Other Work ............... (Description) 4. lEft,mated Cost ....... ~/I ................................................................... j.'~ ~. .' ~;~' ,.~ ~;~-~..:~ ;.~ , ~ ~ ~ .(to be paid on filing this application) 5. ~T~ellinff;hu~br fff,~ tg units ............... Number of dwelhng units on each floor If garage, number of cars .... [.. ~ ................................ ; ............... ' ............... 6. If business, commercial or m~xeld occupancy, ~ecffy nature and extent of each. type of use 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Heighi ............... Number of Stories ........................................................ D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ................... ;... HeiSt ...................... Number of Stories ..................... 8. Dimensions of entire new const~ction: Front ............... Rear .............. Depth ............... Height ............... N~mber of Sto~es 9. Size of lot: Front /~ o ~ Rear .............. Depth ..................... 10. Date of Purchase .......... ~ ................... Name of Foyer Owner ............................. 11. Zone or use district in which p~em~ses are s~tuate ..................................................... ' '~1 ' g 1 12. Does proposed construction v~ ate any zomn aw, ordinance or regulation: ................................ 13. Wflllot be regraded ....... ~ ' ' ' · .Yes.. No . [.~ ............... Will excess fill be removed from premises. 14. Nme of Owner of premises . ~.../~ff~.~ :... Address ................... Phone No ......~.' ". ...... N~e of Architect .. ~.. ~..~ ................... Address ................. ~ Phone No ............. N~e of Contractor ~.t./J.~ l ~.A ~*~/~ ~../~a&e~..~ No · If yes, Southold To~ Trustees Pem~t may be required. PLOT DIAG~ Locate cle~ly ~d dis~ctly ~1 bufld~gs, whe~er existing or proposed, ~d, indicate .~1 set-back d~ensions from prope~ ~es. Give street ~d bloc]: number or desc~ption accord~g to deed, ~d show street n~es and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ...... ~..0...~./~ ~J],),,, ,~,: f~'g../.L..(-..~,~. ..... ; .... being duly sworn, deposes and says that he is the applicant (Name of individual si 'ning contract) above named. ' He is the ................................................................................ (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 cofltained 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 this ............... ~.~'. ...... day ~f....' ~ .......... , 19 .~.4 SUFFbLKCOUNTY ---. DEPT. OF HEALTH- ~ RJVERHEAD ~.y. 11901 BODERtCK VAN TUYL LICENSED LAND GREENPOrT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO the STANDARDS OF The SUFFOL.KF'%DEP~.T Of~HE~th SE~VICES. ~PLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL Of DATE' ~":/ /// ~ - . ~-~ _ SUFFOLK CO. TAX MAP~ATION: DIST. SECT BLOCK PCL' OWNERS ADDRESS: DEED: L ",' . TEST HOLE : ,~4Lz ,it ~I~RTIFIC~.TE OF OCC~UPANCY, I[ ,'Ol~per',tubing is used ~ for water d~str but g system~ piping shall be Of types K or L 0n!;y OIICll?~I'~¥ OR USE iS OF OCCUPJ~N,C¥ V/ NOTIFY BUILDING DEP~rTMENT AT 765-1802 9 AM TO 4-"PM FOR THE FOLLOWING INSPECTIONS: LI. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH- FRAMING & PLUMBING, 3. INSULATION 4. FINAL - CON'STRUCTION BE COMPLETE FOR C.O. ,, ALL CONSTRUCTION ~HALL MEET THE REQUIREMENTS OF TH£-N.Y. STATE CONSTRUCTION & ENERG"/ ',,,, CODES. NOT RESPONSIBLE FO,~,~'* DESIGN OR CONSTRUCTION ERRORg. -i