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HomeMy WebLinkAbout14062-z FO~ NO. ~ TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 14062 Z Permission is hereby granted to: ~'~ ._~ ...... ...... at premises located ~t ...~..D....~. .......... , ............ ............................................... :.i...:.:.;'.: ............ ~ ............ · ...................... County Tax Map No. 1000 Section .... ..~....~..,~? ......... Block .~ ..... ,.~.,.~....i..~" ~l-~t No....~...~ ............. pursuant to application dated ........... ..~....~....]..~ ......... .,....;.,' 19,~.~..% and approved by the 8ui{ding Inspector. Fee $..~..: ............ Building Inspector Rev. 6/30/~80 SECURITY FENCE SYSTEMS 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~. k. bA~.. Approved ....~.%~. \~..., 19 .~.~. Permit No. J .q..o..t~.~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERI~IlT Received ........... ,19... INSTRUCTIONS a. Tkis 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 pub~c 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 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~, inspectio~ns.~-' . .o..~o c ~ r,x . .t:,.~ .~,~. ~ ~.=.~ ......... (Signature ~applicant, or name,, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·. ~.e~,~,~ t7 ................................................................................... Name of owner of premises ... B., ~,'~ . .~. t~'.~, 'i;~R4~.'~L~];:ff;~.'I5a''n~'~'*~' .A.~..;~1:.~.~. ~-- .~ ....................... (as on the tax roll or latest de[r'dv~ : . ' · ~EE:,~.-' BY:. P'~.~.L. If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDTNG DEPARTMENT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDAYION = TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL . Cr~N'STR[jr--!-t©N M/JST 8E C~'~A4DJ UTF F(?R C. O. ALL CONq:~:!CT[ON SHALL MEET Other~Prade's License No. THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONS BLE FOR l. Location of land on which F [ work will be done ...................... [~E$1GN 'OR CONSTI~[/'~'PIb'~ '['R'~(~RS ........ & ........... S.o,.,=k. o.l.J..c N.y. .............. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~, .~ ........ Block ....... ~ ......... Lot .... ~. ............ (Name and title of~ Builder's License No... Plumber's License No.. Electrician's License No. Subdivision ..................................... Filed 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 ..~.e-.e.,~o~"C~...o.J..~e. op.~cT . b. Intended use and occupancy ~¢.q~..z~.t.k,~7~[~ ~-.-C..~.~,.:.'r'.O. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repai,r,... "~tlfl ..... Rem?al .............. Demolition .............. Other Work...~.~r~er-P~ .... (Description) 4. Estimated Cost 1.~. ~..~.: .9..O. ..................... Fee 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. I:f business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D/mensions of existing structure.~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories.. ....................................................... Bimensions 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 ...........i ....... Rear Depth 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ................................................... 1 2 Does proposed construction viol'ate any zoning law ordinance or regulation: 13. Will lot be regraded ......... ~. -_.._~..i .................. Will excess fill be removed from premises: Yes No 14. Name Of Owner of premises . .k~..~.~x~. ~ ....... Address ................... Phone No ................ Name of Architect . ..... , ....j ................. Address ................... Phone No ................ Name of Contractor .~'~'h.~\~.Gk. ~i .~NX ....... Address ................... Phone No.-) ¢1.'.~..~ ..~.cl .el ..... PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or c'orner lot. STATE OF NEW YORK, , COUNTY OF ................. ............................. ,, .................... being duly sworn, d~poses and says that he is the applicant '~'(Name of individual sigujng contract) above named. He is the (Contractor, agent, corporate officer, etc.) of 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ............. ~'. ~.~ .... day oi.. Nota Public ...... ; .. ounty te~m E~p~r0s ~arct~ 30,n 1~7.'~ (Signature of applicant)