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Home My WebLink About14609-z FORM NO. 2 TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fl-HIS PEPJv~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14609 Z Permission is hereby granted to: ....... ................. ~'-~..?... .~.~:..V..,...tz.'t..v../ ......... ~ o . . . ~. . . . m . . ?. . . . . . ~. . . . .c. . . . . . . ?. . . . . . . .~. . . ,~J~:. ~ ~ . . ~. . ..~. . . . . ~. . . . . . ~ ....... at premises located at .-~....~'[/..~.....~....~......~.,....~...~.f~L,, .......................... County Tax Map No. 1000 Section ..... .(~...'~...~.. ...... Block ....... ..c~.....~J[. ...... Lot No ........ .~. .............. pursuant to application dated ..~.~...!..~.. .................. , 19..~...~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Examined.. Z°~'~ .~ · Approved...~..~ · 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19¢¢- Permit No.\ .~ .[o.~..~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ~19... FBI 4 1986 DEPT. , TOWN OF SO~O~ INSTRUCTIONS 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. ~i3~ of this application; the Building InSpector Will issued a Building Permit to the applicant. Such permit shall for inspection throughout the work. e. Nc or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have nspector. ~t,.~l~.lding Department for the issuance of a Building Permit pursuant to the ~[~$~, Suffolk County, New York, and other applicable Laws, Ordinances or ]~il~;*a~lditions or alterations, or for removal or demolition, as herein described. The ~a~plicable laws, ordinances, building code, housing code, and regulations, and to admit ~Ind in building for necessary it~spections. , .................. ~ (/(Signature of applicant,,or~am~, if a corporation) ~t)X ~?. ~" iMailing address of'a;;iicant) ........ State whether applicant is owner, lessee, agent, architect, engineer, general contracj~c~nA~l~r~ builder. of owner of p emises ..... a. .................. , .............. (as on the tax roil or t~tt!Ii'~e~I)JILDING DEPAFITM~NT AT 765-1802 9 AM TO 4 PM FOR THE If applicant is a corporation, signature of duly authorized officer. FOLLOWING INSPECTIONS: ,.-- 1 FOui~JDATION TYVO REQUIRED .............................................. FOR POURED CONCRETE (Name and title of corporate officer) 2 ROUGH FRAMING & PLUMBING 3, INSULATION Builder's License No. ............ 4, FINAL CO~STRUCYIOh~ ~V/UST ~E CO~PLE'rE FOR C,O, Plumber's L~cense No ...... .~.. ................ ALt. CONS'~RUCTION ~$14ALL ~EET ~, YHE REQU~EMENi~,$ OF rile N.Y Electrician's License No , . . :.~ STAT~, CONSTRUCTION & ENERGY ........ '~ ............ CODES NOT ~$PONSlOLE FOR Other Trade's License NO' , ..... .~. mES~GN Of~ CONSTRUCT{ON ERRORS. .............. 1. Location of land on which proposed work will be done ...................... :~ ......................... ......................................................... H .o,. '.1:2. House Hum bet Street Hamlet County Tax Map No. 1000 Section ...... 7.~. ........ Block ..... ~ .......... Lot ..... 7.. .......... Subdivision .~.~¢.,..~..~(,,-L.~...~..~..T./t: ./~'7. .... 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..~.....~'.~...b~. I..I..~ .... .P..~.. ! .v..]k.'.lT. ff.....~..~..i .~. F..b~..~. {:'7. ................... b. I~tended use ~pd occupancy'..N'.~... ? !~ .~..~.~.~'.~..g'~" .~.~! .~.~.~...~..~....~.O.~.....~..~.K/..~..1~..- .......... 3. Nature Of work (check which applicable): New Building .......... Addition...i. Repair ..... : ........ Removal; ............. Demolition ............ . 4. Es imated Cost .............................. Fee ........... ...... Alteration .... ':. ~.~ Other Work/'? .~P¢.~.~.) .~. (Description) (to be paid on filing this application) 5. If dwelling, number of d~elling units ............... Nuinber of dwelling units' on each floor If ara e number of cars ~ .. ~. . . g g ' ''. ................................... ............... : '~/ ...../::[~J~/~6/ 6. If business commercial or mixed occupancy, specify nature and extent of each type of use ...; ..... 7 Dimensions of existing structures, if any Front...~1~.0., ........ Rear ...t~/~/..! ...... Depth..~.g~../~.~.~ Height . ,,~ ~' .......... Number of Stories..~ ......................... . ............... (.. ....[.g... Dimensions of same structure with alterations or additions: Front ............. i .... Rear ...... -J' 'l '~'~' Dept ...................... Hmght ...................... Number of Stones ........... ~ ~b/l~/. 8. Dimensions of entire new construction: Front ............... Rear ......... i ...... Depth ... · Height ...... Number of Stories ............ .............................. ~.j. 9. Size of tot: Front . .[ OO' ........... Rear. t /.~O' De_,Pth o7~ ./16a~.'. 10. 'Date of Purchase .. tfl.~',,q~ .............. ~a~ 'o'f'F'd~dr'6~v'n'e'r~, .~.,.l~j~.'~.t,.~.i.~ '.~'.~.~.'.~,~.'. 1 1. Zone or use district in which premises are situated · .~. iii ~ I0 ~:N 0',+. l- "',A, ~'.. 12. Does proposed construction violate any zoning law, ordinance or regulation. . DJ./?'. .......................... 13. ' . . Will lot be regraded .../~J/2. ........ : .,, .... :,,... Will excess fill be removedlfrom premises: 14. Name of Owner of premises J~.~.~. ~-.~. ~..~..VC.'Ot.J..g,. Address .,~.d..~. y.~.q I,~, 1~/..~.. Phone No. ~.& .~'FY.e~ ~' o~.N. 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 showistreet names and indicate whether interior or corner lot. (Name of individual signing contract) ~bove named. Heisthe O tO tO C A k[~l J ~ ~. . .'. . ~ (Contractor, agent, corporate officer, etc.) i said owner or owners, and is duly authorized to perform or have performed the sa!d work and to make and file this ~pplication; that all statements contained in this application are true to the best of his ~nowledge and belief; and that the sork will be performed in the manner set forth in the application filed therewith. ' ~worn to before me this : ........ //..-~. fl. .......... dayof... ~. -g~.A.~A,~'-/ 19'~'6'/'~ ~,f~ ~g~t; ' ~qOl, ary Public, State of New York No. 4842180 .............. ......../~.~_,'/[~'j-/~ ~-~ [---- it ........