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Home My WebLink About14383-zNO TOWN OF SOUTHOJ.LD..--.~ BUILDING DEPA~,,?GENT ~ TOWN ~ ~ SOUTHOL~D, N.Y. ~ (THIS PERMIT MUST KEPT ON THE PREMISE~NTIL FU) COMPLETION OF7 WORK AUTHORIZEDD) _. ~ 14383 Z D~, ...... .~..~.....!.:~ ............. , ~.~.~. Permission is hereby to ~t premises located at County No. i00( pursuant to BulldJng Inspector. ...c~.~~....~.~ .............. , ~..~.~, or~ ~pp,~.~ by th. Fee $ ~.~,~ .: ............. Building In,pector FIELD INS~ECTION COMMENTS FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & ?LUMBING INSULATION ?ER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: / / / i O¢¢U?AN¢¥ OR USE iS UN~WFUL WITHOUT CF..R*[IFICA~'£ OF, OCCU?~NCY APPROVED A~ NOT{~ {zo 'FORM NO. 1 ~ ," TOWN OF SOUTHOLD ~ ~ ~I~U i'L~DI'NG DEPARTMENT " TOWN HALL ~.OUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examined . .O-. . .I. ~., 19 ~.~. Approved· ~ ~..[.~.., 19~ .~. Permit No.~.~.~..~.~..~. · . Disapproved a/c ..................................... ~ rk/h ..................................... . ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT - BLDG: DEPT. - TOWN OF 8OUTHO,LD Received .... Date ................. 19 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 ~ 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 remov31 or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,~ ~t. ~building code/housing code, at:Id regu3ations, and to admit authorized inspectors on premises and in building for necess~~ (S'~cant, or name, ~W-a corporation) · 2.7..~./.,.~.c/.4 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... ~.~ .~.a% ................................................... N~me of owner of premises....V~.~.X.. ~ ~ ~ .~...kT~..... ~.,/.~.~ ~ ............. (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 ......................... 1. Location of land on which p~)posed work will be done.. ...................... = .......................... .... ~.7..sT .......... p~. y/.~..~ ~..~x.~ ' .~?. ~.~..~.o c~o ............... House Number Street Hamlet County Tax Map No. 1000 Section ....... .~.~. ...... Block ...... .~(.. ......... Lot ...... ......... Subdivision .... [ ................... Piled 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 .... ~.~.~../~..~.~.~.... ,~...~..~.~ .~../.~.. .... ~..~.~:9...~...,..Z~.../~..&.~[ ...... b. Intended use and occupancy ........ ~'~ ...................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .......... ;...,Other Work .~...TJX.,, ~..ff?~.~.. 4 E timated Cost-- ~.~. ~.O. (Description) · s . ....................... . ... ....... . Fee ......... i ........................ · · · · ~ (to b~' paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, numbc? of cars ........................................... I ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ ; ............ 7 Dim sions of xisting structures if a y: F t Rea ' Depth · en e , n ron ............... r ...... ~ ....................... Height Number of Stories ' Dimensions of same stn~cture with alterations or additions: Front : Rear D pth ...................... He,ght ............ ? .......... Numbar.of Stones .............. v ....... .... ~f IZ ' D~mensmns o£ el~tire. ~new construction: Front... ~']..c/,. ~.¥ .... Rear .../.~..~. ~.~. .... Depth .. f...7...Z. ..... ' 9. Siz;oflot: Front ..... /.?. ~-..~t~.-~ .... Rear. i ...... f..,~...~., ii~.'~.7'~..i Depth ..... 10. D te of P roha,e ....... 62. Z ....... Name of Fo,mcr t7. 11. Zone or use district in which premises are situated ........................ I ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .. i ....................... 13. Will lot be regraded .................. ,,...~. ...... Will excess fill be rejuov~ed from premises.;. Yes No 14. Name of Owner of premises .~..~.O..~..~.~..C...~..~..~. Address ...-~...~'ff~. ..... E- ..... Phone N~. 16z,,~ Name of Architect ....... . .................... Address .................. Phone No ................ N~une of Contractor .......................... Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail 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 shbw street names and indicate whether interior or comer lot. . . STATE OF NEW YORK. COUNTY OF ...... S.S ,,. · .~,/~.~/~../77 ~.~...~..~ .................... being duly sworn, d,poses and says that he is the applicant (Name of individual signing contract) above named· m is the ................. ~.~Z4 &'~d ............................... .............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or haw performed the said work and to application; that all statements contained ~ this application ~e true to the best el his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this .... Z/'~Z'. ........... day of. ~~C_~ ...... 19~ N~ta~ Pubhc, . ....... .~,~-~.~.: ......... County , . ~- (~lgnaiuro et applicon) Te~m Expires March 30, 1;~ SURVey FOR THOMAS P, ~ HELEN D. Mc HERN~y AT ~OUTHOLD )'0',7~ OF' SOUTHOLD ~'U,:POLK COUNTY, ti y SEPT. I~q, 1973