The URL can be used to link to this page

Home My WebLink About14655-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission ~s hereb/granted to: .... ........ ................ ot premises Iocoted o, .....~..~. ....... ~.~......~--,<'~.: ...... . .~..~{~...o~ ........................... County Tax Map No. 1000 Section ...... ..O....~..~ ...... Block ...... .~..~.. ....... Lot No ....... .~. ............... pursuant ,o applicotion doted .... .~..~~...~,.~ ............. , 19.~..~.., end (~pproved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD FOUNDATION (1st} COMMENTS FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: -). ~BRECHT & QUISiT 277 Park Avenue York, New York 10172 (212) 207-1400 ,.r e d Hundhammer 'FORM NO. I "~ ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 · , 19~..(*. Permit No. ~. Disapproved a/c ......... : ........................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. 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 g 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 remolval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildiI~ code/ttousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~~ (Signature of applicant, or name, ff a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~.~..~....~..~..~..~.~..~../~..~..~..~..%..0.~...A~...80.~..~..~..~../~. ~.~..'~. ..... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land, gu which proposed work will be done .................................................. ..... .... ........ .... House Number Street Hamlet County Tax Map No. 1000 Section ............... Block .... . ............. Lot ................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and. occupancy of promises and intended use and occupancy of proposed construcfion: a. Existing use and occupancy ............... .~. ....... /' '~'/'t .................... b. Intended use and occupancy .............. ~...~...~....~....~. ~...~:7.. ......................... .... 3. Nature ofwork (check which applicable): New Building ..... ' .....'Addition ...~f ..... Alteration ... I ..... Repair Removal Demolition ~ Other Work ~ (D riptio ) 4. Estimated Cost ........... t ..................... Fee ........... ~ ......................... (to be p~id on filing this application) 5. If dwelling, number of dwelling units ...... O..A{..~. ....Number of dwelling units On each floor ............... If garage, number of cars ...... A}.O.~--. .............................. ~ ........... ~ .~, ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each type:of use .... .~.'.~...2.t., ,, ...... 7. Dimensions of existing structures, ff any: Front .... ~...~, ..... Rear .. ,~.~... ~ i ..... Depth . .'~..~. ....... Height .... .~ gr. ...... Number of Stories .2Jf.'~ .... i .......... *'--'~t ..... ................... , .~' ....... ~?~ ~ Dimensions of same structure with alterations or additions: Front ... ~. ~..~ .... ! ....Rear ............... Depth ...~tl~ ...... Height .~.~ ......... Number of Stones... ~,t/(~, .... t'~ .~, ..... 8. Danenslons ~f e~t~re new constructmn: Front ............... Rear ..... ~.~. ~. ..... Depth ... tt.~...~. ...... Height ... ~..ff~ e. ...... Number of Stories ..... .] ....................... ........................... 9. Size of lot: Front .... .,~t..t ............. Rear ~ t ..... .~ ............... Depth ../.q.o. t .... 10. Date of Purchase..~'/~.~.~. ~.,~. ................. Na~e of Former Owner f./.~..~.. [ ~ ~.,~. ~ ~. ~.~: ~ 1 1. Zone or use district in which premises are situated ...... ~.~-.~.~..~.."'/ff~.. ..... : ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.~.i ........................... 13. Will lot be regraded ...... ~¥t~. .................. Will excess fill be, l;.emoved Ifrom premises:~ , Yes No 14. Name or Owner of premises . t6(~,~ ~t/~4~..~ .... Address,~.O..~..~.7..~.....4/.~. ~'. j... Phone No.~!~...~.~.Z ~r~.~.. Name of Architect ~..r.~.~..../~...~.~.~..~. ......... Address ~f~.~: .~' .~...,yy..e... Phone No./';~>.). Name of Contractor .......................... Address ................ i. · · Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, grid!cate all set-back dimensions from property lines. Give street and block number or description according to deed, and showl street names and indicate whether interior o~-corner lot. STATE OF NEW YORK, ~ S.S COUNTY OF ................. ......... .... (Name of individual signing contract) above named. ........ being duly sworn, deposes and says that ae is the applicant- make trod fil'~'this )aliefiand that the ' He is the... ~. · ./~..~. · .~. ........ i~ontractor, .............................. agent, corporate officer,' etc.j' ........................... , ' , ~f ~' ............ ly hid work and to ................... , and is du authorized to perform or have performed the s. application; that all statements contained in this application are true to the best of his knowledge and work will be performed in the manner set forth in .the application filed therewith. Sworn to before me this ....... ........... day of ......... Notary Public . ./f..~,d .~/~./.? ...../ County ,, ~/~ applicant) OF or UNLAWFULI CERTIFIGATE ir¸ I/4n =1'.,0~ L~KOW ri'7., A~ROVEO AS NOTED ~TI~ [~d~LE)lf. iG DEPARTMENT AT 180~ ~: '~* ~;'O 4 PM ~R THE I/4..?= tuO" ' .