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Home My WebLink About14751-z FORM[ NO. 1~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? li751 Z Date ...... ~. .......................... , Permission is hereby gronted to: County Tox Mop No. ]000 Section ..... .~..~....~ ...... Block ..... ..~..,,...)='.. ...... Lot No ...... ,,~',..,~. ........... ~.....? ........................ , lO.~...~., ond approved by the pursuant to application dated Building Inspector. Building Inspector Rev. 6/30/80 FIELD INS~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER No Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined . .(~'M~....I.I .... , 198..~. Approved .~.././...., 19~..('. Permit No../.z-!.7.~..J. ? Disapproved a/c ..................................... Received..~ ......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .... , 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 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 or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here/m described. The applicant agr. ees to comply with all applicable laws, ordinances, building4;,ol~e, housing code, and~regulati~ons, and to admit authorized inspectors on premises and in building for necessary inspec~"o~i's,/. /7 // // (Signa~~, or name, i~~) · ................... (Mailing address of applicant) State whether applicant i~lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. e · (as on the tax roi1 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.. [./....~..X. .............. OtherTrade's License No ..... Q.'C ............[ j // .~. . /.~. . . . .~. . .~. . 1. Location ofland on whjqh proposed work will be done~ .v.'.('/..~.~..~. ...... .'7-. ........ ................................................. House Number u Street(/- Hamlet County Tax Map No. 1000 Section . . .0.~..~. ....... Block ..... ..~. .......... Lot....?..~.: .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy o,~remises and intended use and occupancy of proposed construction: a. Existing use and occupancy..&.M~.-?o.,..'-x~'¥~,~..~. .... ;. ......z-z ............ ~ ......... ~_~ ...... ,.- b. Intended use and occupancy 4. Estimated Cost... 2 ........ 5. If dwelling, number .../. If garage, number of cars Nature of work (check which applicable): New Building ..... ' ..... Addition . 'i ........ Alter~io~ ......... Repair .............. Removal ............ Demolition ........... .... Other Workl/:~q(. (Description) (to beipaid on filing this application) ng units o each floor " ' 6. If business, commercial or mixed occupancy, specify nature_and extent of each type of use *- .... 7. Dimensions of existing structures, if any: Front...~..~..~'.. Rear .... c~.~. ...... 'l~t't~ Height .... ~ ..... Number of Stories .... ~ ............. ~ ....... i ................... : ........ Dimensions of same structure with alterations or additions: Front ............ ~ ..... Rear .................. Depth r ~ Height '"---'-~' Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ........ : ....... Depth ............... Height ............... Number of Stories ............................ l ............................ 9. Size of lot: Front ...................... Rear ...................... !Depth ...................... 10 Date of Purchase Name of Former Owner ~ 11. Zone or use district in which premises are situated ......................... ~ ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ... i ............................ 13. Will lot be regraded ............................. Will excess fill be remov4d from premises: Yes No 14. Name of Owner of premises . .C:I./~. ~ .5... ~.~ ~Address ??.O.t .ft&O~a..O~O,~... Phone No..~ 2.~ :~, ?..dT.~. ~... Name of Architect ........................... Address ............... i ....Phone No ........ Name of Contractor .......................... Address ............... ~ ....Phtgne No .... .~ ........... 15. Is this property located withinl.00 feet of a tidal wetland? *jYes ..j~.. No .~.. * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. ~dmate 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 YtO/~K, ~ S S COUNTY OF .... ['~'[~'5:''' I~ .............. . .,~... ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : Heis the "~ (Contractor rporate 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 contained in this application are true to the best ofhi~ knowledge and belief; and that the work will be performed in the manner set fg.r{h in the application filed therewith. Sworn to before me this / ~ ~ ' ........... I ........... dayo ........... .. ........................... Notary mubhc~ ~ .~. ~..-~/..~. Count.~ re of applicant) HI~LI~N K. DE NOTNA~RY PUBLIC, State of New . o, 4707~78, Suffolk County ~'"7 .ermExpiresMa,chSO, l~ ~ ! ~ ~