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Home My WebLink About14045-z FO]~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. ('rill BUILDING PER~IT MUST BE KEPT ON THE PREMIS OF THE WORK AUTt UNTIL FULL NM ,045'Z ot premises County Tax Map No. 1000 pursuant to application dated Building Inspector. Pee .... ..I,4-~/~,..L..~'... ................ , 19.~.~.'~., and app by the Building Insl:~ector Rev. 6/30/80 FIE[~D I~$FECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY ~ODE ~MENTS: FINAL (2nd) 'FORM NO. 1 TOWN OF(g'OUTHOLD BUILDING DIEIPAR TM ENT TOWN HALL $OUTHOL[3tJ N,Y, 11971 TEL,: 765-1802 Disapproved a/c ....................................... (Building(~nspector) APPLICATION FORi~UILDING PERMIT INSTRUCTIONS Received ........... ,19... 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 accords, to schedule. b. Plot plan showing location of lot and of ~gs~ emises~relationship to adjoining premises or public streets or areas, and giving a detailed description of~o~l~pK~ ,m~rawn on the diagram whichis part of this appli- c. The work covered by this app 'cq~n~.~N~'r~ g~Tire~-- issullnce of Bufld~g Permit. d. Upon approval of this appli~~~ ~issued a Bd~{dhg Pemit to the applic~t. Such pemit shah be kept on the premises ava~ fg[~s~~ ~he work. e. No bufld~g shall be ~e~or: ug~d~*~ ~r any purpose whatever until a Certificate of Occup~cy shall have been grated by th~'~g Inspdeto~x ~PLICATION IS HEREB%~DE to ~e B~a~ merit for the issuance of a B~lding Pe~it pursuit to the Bffilding Zone Ordnance of the ~n of .~ou~~County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of bUg~gs~&~:~terations., or for removal or demolition, as here~ described. , okdlnances, bufldi~de, housing code, and regulations, and to The applicant agrees to comply wit~h~s admit autho~zed ~spectom on premises ~ b~d~g for'~essa~ in~c~~ ~n' '" ~igna~ g; ~ame/if ~ ~;;~a~d ') .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect,xengineer, general contractor, electrician, phnnber or builder. .4 ................................................ Name of owner of premises ..... ~../~.(-....~... ~'~ ~O~ ..... ff~flff~ ......................... (as on the tax roll or latest If applicant is a corporation, signature of duly authorized~ officer. DAT~: ~//~' -B' P' ~ ~ (Name and title of co~orate officer) Ncr'"~: .... ',n DING DEPARTMENT AT 7~ ~,.~ o AM TO 4 PM FOR TH~ Builder's License No. ....... .......~ /~ . ...... . .. FC' ~ ~"~'~'"~ "'c. PECTIONS: 1. V"~?'"~"~'~'~ - TWO REQUIRED V~- r>~l', :~ C~NCRETE Plumber's License No .......................... 2. Rcx~c-'.~ ~ ~q~ & ?kUMBIN~ 3. Electrician's License No. 4. F[F,~L c'"'"'-""'"-'~qN MUST Other Trade's License No ...................... BE l. Location of land on which proposed work will bc done." ~ ~AT[ CONCTRUCTlnb' ~* -' .... Y 5.4 -.fi.c .... __~;useNumfi;;"'~__ Street qt ' .......... ¢~ CONSTRUCTI% 5: ..... ~ '. County Tax Map No. I000 Section ..... ~ ~ ....... Block ...... '. & ........ Lot ...... 1 ~ .......... Subdivision ..................................... Filed Map No ............... Lot .... ~ ~.. .... .... (Name) 2. State existing use and occupancy of premises and intends0 use and occupancy of proposed construction: a. Existing use and occupancy ~ b. Intended use and occupancy ....................... ~%' '~:"~ 3. Nature of work (check which ~pplicable): New Building ..... ' ..... Addition .......... Altera2~on ........... Repair .... Ren{oval ....... Demolition .... Other Wod~ (, ~J//'1/~t/'~ 4. Estimated Cost l.,~c/c/ ' °C) ~ ~,~' ! ~ I~ ~' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ~ ............... 7. Dimensions of existing structures, if any: Front ............... Rear ........ ~ .... Depth ............... Heigllt .......... Number of Stories ....... ~ ............ Dim 'ons of w'th It tions radd't' Front Rear -'" ens~ same structure ~ a era o 1 ions: .... ~ .............................. Depth ~ Height Number of Stories 8. Dimensions of entire new consiruction: Front ............... Rear "~-' Depth Height ............... Number of Stories .......................................... ~ .... 9 Size of lot: Front Rear Depth --f 10 Date of Purchase ' Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vi~olate any zoning law, ordinance or regulation: .................. ...... · ~.'(:~. .................. Will excess fill be removed from premises: "(Yes')'" 13. Will lot be regraded 14. Name of Owner of premises . .] .................. Address ................... Phone No ................ ~ Name of Architect , Address Phone No Name of Contractor ....... ................... Address ................... Phone No ................ PLOT DIAGRAM I,ocate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STALE OF NEV~ YO, I~K,. ~ S S ...... ,~//..°..~..r~../9..'~. · ./{ .'..~.~/.~. {":c/ ................. 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.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contlained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... .......... day or .............. , I9 nOTARY F'USLJC, Stme of New york -- c (Signature of a/pplicant) _Ne. 4~22Be~, Suffolk lerm F.,xpir~ Mmeh 30~ 1~.~ ,i