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Home My WebLink About14486-z E~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) NB 14488' Z Permission is hereby granted to: ....'m...~....r~ ....... ~:~.-.~.~......~.:~.: ,o ~...m........,..~..~....~.~0.......~.~..~....~.~...~ .......................................... ................................................................ "' "l~o~ ' ~~ k,...: ........... at premises located at ...... .~ ................. ..~..~m~...~-~ ...................................... :.CJ. ..................... County Tax Map No. 1000 Section ...... .~.~....~.. ....... Block ..... ..O....~.~.. ........ Lot No ..... J..~:.!. ........... pursuant to application dated~......~...?. ................ , 19.~,.~.~ and approved by the Building Inspector. Fee $....,~. ........... Building Inspector Rev. 6/30/80 FIELD IN PECTION FOUNDATION COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~.'"~~. ~."/., 19 t?. Permit No. ! ~.~..~..~..~.. Received ........... ,19... Disapproved a/c ..................................... ...... il~ii~t~}i ........ 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 thi~ 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 herein described. The applicant agrees to comply with aB applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa.~...'nspecti°ns'~(z_Q~?__....~.....~-~m~,,~ .......... (Signature of applicant, or name, if a corporation) ...... (Mailing address of applicant) State whether applicant is owner, lessee,~rchitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .7296~..~... g2..~....~.td./.-?.~...Z~-./.-. .......................................... (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. ~.'.~. (t/~.. Plumber's License No ...... 'l .................. ! Electrician's License No.. 'WI ......... ~ ........ Other Trade's License No ...................... 1. Location of land on which proposeS work will be done .... .... /.,..~...,Gr/c/e...o..-<.....~.,~,~.~....~.o.d~.../,~../.-; ............................. It0use Number Street Hamlet County Tax Map No. 1000 Section ..... .7. ~. · ....... Block .... ~.. ........... Lot .... J..~.: ./. ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premiies and intended use and obcupancy of proposed construction: a. Existing use and occupancy '...-77'.t9-'~ .... bO.. ~".... ~.z/-~-. ~.... ............................... b. Intended use and occupancy .... ~/~./JP'-~/;.~....~.~.~ .~../.~.....~..,~...o/... ,d.~. A?~..,~.. Ji'~.. ~.~..... 3. Nature of work (check which applicable): New Building.....~f~..... Addition ........... Alteration ., ........ - Removal Demolition .~!. Other Work Repair ...................................................... (Description) 4. Estimated Cost ....................... Fee ...................................... (to be ipaid on filing this application) · 5. If dwelling, number of dwelling units ............... Nflmber of dwelling units on each floor ....... : ..... If garage, number of cars ............................................ i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..; .................. 7. Dimensions of existing strudtures, if any: Front ............... Rear ....... : ....... Depth ............... Height ............... Number of Stories .. ~ .~-,~. :-:-. ................ ~ ............................ Dimensions of same structure with alterations or additions: Front ~ Rear .................. Depth ...................... Height ...................... Number of Stories ...................... '-8. Dimensions of entire new construction: Front ............... Rear ........ ! ....... Depth ............... Height Number of Stories 9. Size of lot: Front ...................... Rear iDepth ...... 10 Date of Purchase Name of Former Owner · Zen distri t in whi h pr mises itu t d ...... . ..... 11 eoruse c c e ares ae ......... · .......... ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................ 13. Will lot be regraded ...~/..~. :.~ ..... Will excess fill b~.,r~oveld from premises: Yes 14. Name of Owner of premlses .~f/O. i ~.' ~.'~i(~.~ . Address .~7~. Ittzr~. ..... Phone No..7~. S7:.'7l 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 lo~. STATE OF NEW~4DRK, m , , : COUNTY OF, .~t~_~... a'o ........ x,.,}~,',~.'...~. ..... ~~~'.... being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................................ (Contractor, agent, corporate officer, etc.j Of said owner or owners, md is duly autho~zed to perform or have perfo~ed the ~aid work and to m~e and file this application; that all statements contained ~ this application, are true to the best ofhi~ knowledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this Nota~Public,~~~~_.~ ....................~~~~ ~ Coun;~ ~~~~ ~ c~n O .... ~:~ ~--~[~~~~ (Signature of applicant)