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HomeMy WebLinkAbout14801-z FOR~l NO. it TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOI. D, H. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 148O1 Z Permission is herebt granted to: =================================== Ot premises located at ..... L./,..~....~,.....~..~,.~~.*--~.. ........................... County Tax Map No, 1000 Section C~'~ Block ~ Lot No .......... ~ .......... pursuant to application dated ........ ~.~. ....... ~......~.. ........... , 19..~..~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 3. Nature of work (check which applicable): New Building ' Additi ... Alteration Repair .............. RemoYal .............. Demolition .............. Other Work ............. (Description) 4. Estimated Cost...~7~>.-- .~.~ ......... : .............. Fee ...................................... (to be paid on filing this applicatior ) 5. If dwelling, number of dwelling units... ~. .......... Number of dwelling units on each floor ................ If garage, number of cars ....................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dhnensionsofexistingstmctures, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ......... > ............ Number~of Stories ...................... Dimensions of entire new construction: Front ../.~.. ......... Rear ./.~. ........... Depth . ~(.d~../. ........ .... ah ...... t~mbe .... to .............................. 1 0. Date of Purchase ...... /. ~. ~.~ ................ Name of Former Owner ~ ~..'~ ~. 1 1. Zone or use district in which premises are situated.. ~ ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .~..~. ......................... 13. Will lot be r~g~aded ~..t~ ....................... Will excess fi[l~e removed from premises: Yes 14. Name of Owner of premises t~fi'~.~'.z~. ~72~7~.y. Address -x~..y~{'.~?~'~./~2~.'~/~4 Phone No ~.~g'~ Name of Architect ........ .~ .................. Address ...... .~. ........... Phone No ...... .~ ......... Name of Contractor ........ ~. ................. Address ...... ~.~. ........... Phone No ..... ~ ......... 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. £ I STATE OF NEW YORK, S S contrdc.,~,~ being duly sworn, deposes and says that he is the applicant .(~me of indivi~l~l signing above named. He is the ...... ~.. ~..,<~..~. ~ ...................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to p~erform 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 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 .......... i...t. 7 ........ .... ......... Notary Public,....~o.....~.....~.~: .t .~.~...~ ~, ... County ~ ~1.~,~ ~' /~ (/ (Signature of applicant) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ,~~ TEL.: 765-1803 Examined . ~.~..., 19~. ~. Approved ~i Disapproved a/c ............... ...................... ............................ , .... (B'fiilding Inspector) A~LlCATIO~ FOR BOILDI~G PERMIT Received ........... ~19,.. Other Trade's License No.... ................... ]. Location of land on which proPosed work will be done .................................... House Num bet i~ Street Hamlet County Tax Map No. 1000 Seciion ......... ~. ,~..... Block / Lot. ,'~,,~. i (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and obc'upancy i.,,~)~4-<~g~, aC t.. z'eq./~ ................................................... b. Intended use and occupancy . ., ........... '.:'r.'. ........... '-'. ~'. .................. 3 ' ' ..... INSTRUCT.IONS a. Thi~ 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 shale. Fee according to schedule. b. Plot plan showing location ~f 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 applidation, 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 ip part for any purpose whatever until g Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for ~he issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Ybrk, 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 wiih all applicable laws, ordinances, building code, housing code, and regulations, and to (.~l~natu~ of apph'cant, ~r/name, if a corporation) address of applicant) //~'~ State whether applicant is owner,!lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises ~.~__~.~'~. .................... , (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.. f~?~.x~.. ............... . .... Plumber's License No ...... ! .................. Electrician's License No .......................