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Home My WebLink About14525-z FORM NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUiLDiNG PEIU, AiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETtON OF THE WORK AUTEtORIZED) N°. 14525 7. County Tax Map No. 1000 Section ..,.0,,,.~,..~.. .... Block ....~.,.,.,~, ......... Lot No. ,,~',,,(~,,~.~ ......... pursuant to r~pplication dated ~.~.~.~.0~.~...,;.~....., 19...~...¢ and approved by the Building Inspector. Rev, 6/30/f~0 FIELD INSPECTION COMMENTS FOUNDATION ( FOUNDATION ( 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY C,ODE FINAL 1st) 2nd) IG ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 /. TEL.: 765-1803 Examined . ~ ......... 192~.. Disapproved a/c ..................................... 7 (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,1 . . Date .-.~?.~.'.. ? ......... , 19 ~.4'7. INSTRUCTIONS a. Tins application must be completely tilled 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 st'feets 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 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Nmne of owner of premises .... .J.?.h.~...~.~.../.~.r.J.~..m...e...M.~.~.c.'?..[?.~.('{:? .............................. (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 on which proposed work will be done .................................................. · ................. House Number Street Hamlet County Tax Map No. 1000 Section . .?:~ ............. Block..~ .............. Lot...¢ ............... Subdivision... f)fffi v~o D ................ Filed Map No ............... Lot ..... ~ ~(~ (..~.. (Name) 2. State existing use and occupancy of pre~is~ and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... > ............ ~.{.~ ........................ ti;~Jo~..kAq~,l,l ......... appheable) New Building . Addition Alteration ' 9 al Demolition Other Work Rem v ........................................... ~' ~ 2o, 000 !: Fee~. '~.~...~...~.~.~. (Description) ; *-' (to be paid on filing this application) !,~numb~er o f dwelling iunits ............... Number of dwelling units on each floor ..... . .......... garage, number of cars .... i ....... : ............................. : ........ ,~ ........ .~: · ~ .,.,:~ .,. · 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .G?/?.m~..~.q0 ~ .~..r! t.o,/.~f~../.. 7 Dimensions of existing structures if any: Front Rear ' - Depth tteight ............... Number of Stones .................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ................... i · · Height ...................... Number of Stories ..................... -8. Dimensions of entire new construction: Front .~... ~..fit./ .... Rear ...~...~.( ........ Depth.. ~i t .. ttelght .. ~ .......... Nunlber of Stories .':;. ~ne,,....~..~.~ .~.~.~. ..................... 9. Size of lot: Front . .5-'.6. ~... f?.,~. ?., .~'fi/.... Rear ..... .5-.77,~ ............. Depth ...,3..~o.o..t ........... 10. Date of Purcl~ase .. ~.c.&...g.o.,~ ~fi..~.] ............... ~Name of Former Owner....~..o.k~.. ~.e.27. ( .......... ' 11. Zone or use di,strict in which pr~mises are situated ~..~tf:c. ( [ .J~.~! .... .f/.,,.~> f.~..ftfi./. ...................... 12 Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ..... ;,,:,, i · · .~..,~ ............Will excess fib be remoyed from premises: Yes .. ~ ........ .~dd . ~. t ............... Phone No.. ~ ...... ~ ..... 14. NameofOwnerofpremisesQ.O~.~...: 'F~ yso~t~ ress3 g' Jov~, ~/r,~rJ~ 7 ~-~'~ Name of Architect ......... 4 ................. Address ii .bl i i i i i .'~ ........ Phone--St6: .. :; ........ Name of Contractor .~..Q~4~'/.~4. ?..,3.¢.~q,.~..~]~. Address ?' ' ~o.~ ......... Phone No.(.~/.TJ. ~3.4'~.q7.§?~r, : PLOT DIAGRAM ~ ! q 3 o Locate clearly and distinctly alt buildings, whether existing or proposed and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street name~ and indicate whether COUNTY OF .-.~..~: !/~c~fl/_ZcXJ4~. i~ O fi~o,l9 being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. 0~ He is the ...................... . ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duty authorized to perform or have perfo~ed the said work and to m~e and file ~is appbcatmn that all statements contained m this apphcat~on a~ true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ndr set forth ~ the application filed therewith. Sworn to before me this ................. day o .. ., 19 Not ary P ubliCu~A a. ~'' ............ &~~~ & ~/~C°unty (:~ f ~~ V No, ~22563, S~lk Cou~ ' (Signature of applic~t) Term E~ires Maroh 30, lg~ n ~ / I 'Zt-O[[ A ill t ~~t~t~ '"' ' ' , ,, ,' , ,e' ,,e ml,[ ,, " Z~tO ~q BvP Z~¢~O.C. ' , , I lI h