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Home My WebLink About14109-z ~OB, I~ NO. B TOWN OF $OU'~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ,A, UTHORIZED) N9 14109 Z Permission is hereby granted to: ~ ~ ~'~.~ ~-~, ~co .... . ..~.-~~..?:.?-l-: ...... .~..s..~.~L...:.....~. ,o ~~~ ..... ~ .. ~... ~ .......................... ..................... ........ · ~1,,~' ,~ ~'" ' at prem,se, located at ,.'.~.,0, ........... ~',,~;,..,C~.,,.':~),', ...... L.Z,,~,,,,t:~......~~ ...................... County Tax Map No. 1000 Se~:tion .....'.~..~..,~. ....... Block ...~..~ ..........Lot No....,). ....... ..~ ........ Building Inspector. Fee $....~..). ............... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~,, b~X..~. .... ,19'~'?. ^ ,pro,,ed ..... Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN b~ '$b-dl~OLD Application No .................. Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by Wpewdter 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 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 Soutbold, 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 desoribed. The applicant agrees to comply with ail applicable laws, ordinances, building code, ~housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaj~,inspefi4ions, c~O _~ ~/~ ~ ~_(Signature of applicant, or name, if ~t corporation) [ , . V .... (Mailing address ofj~pplicant) / State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. If applic~t is a ,c, orp~atip~gnature of dul~gthorize~ of£Tcr. (Name and title of corporate officer) Builder's LicenseNo .......................... Plumber s License No ......................... Electrician's License No ....................... '~,za,..L Other Trade's License No ...................... ^ ! 5'-[~ , Locationoflandonwhichproposedworkwillbedone~X.~... ~ .~7... .......................................... :. i ii i .i i House Number Street Hamlet County Tax Map No. 1000 Section .... .~..~. h~ ....... Block ...... .Q). ~ ....... Lot .... !.~:. ~ ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .................................................................... Nature of work (check which applicable): New Building .......... Add tion .......... Altera~on ....... Repair ...... RemoVal .............. Demolition ............... Other Work .o.J.~. ~i ..... Estimated Cost ...................................... Fee .................................... If dwelhng, number of dwelling units ............... Number of dwel If garage, number of cars ...... ............................... If business, commercial or maxed~oecupancy, specify nature and extent of Dimensions.. of existing structures if any: Front. ............... Rear. H(Jght ............... Number of Stones ................... Dimensions of same structure wi~h alterations or additions: Front ...... Depth ................. .... i. Height ...................... Nu (to be paid on filing this application) lng units on each floor ................ ~ach type of use ..................... ............. Depth ............... ........... Rear .................. nber of Stories ..................... 8. Dimensions of entire new constr~ction: Front ............... Rear ............... Depth ............... Height . .............. Number of Stories ........................................................ 9 Size of lot: Front ...........!I ......... Rear Depth 10. Date of Purchase ........... i ................. Name of Former £ wner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulatio 13. Will lotbe regraded ......... i .................. Will excess fill b~ 14. Name of Owner of premises ... ~ ................ Address ........ Name of Architect .......... i ................ Address ........ Name of Contractor ......... , ................ Address ........ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed property lines. Give street and block fiumber or description according to deed, interior or c6rner lot. STATE OF NEW YORK, i COUNTY OF ................. !S.S .Z.. .¢. . .: . . :. Q ............ DAT FEE: NOT/ 765-1 FOLLI 1. FC FOI ~. ROI 3. INc 4. FI/' BE ALL "~HE (ODE CESt being duly removed from premises: Yes No .......... Phone No ................ .......... Phone No ................ .......... Phone No ................ , and. indicate all set-back dimensions from and show street names and indicate whether PPROVED AS NOTE]) ',02 9A~ TO4 PM FOR W[HG INSPECT[ONS: JNDATION - TWO ~p , OURED CONCRETE }GH - FRAMIN~ & L)LATION ~ - CONSTRUCTION ,? ~?? ~z~ FOR C.O. MUS~ :'~N?TR~ ~C~ON SHALL :EOUH~:ZMEN'TS OF THE N.Y. CONSTRUCTION & ENEDCV ., NgT RESPONSIBI~ Fd~ deposes and says that he is the applicant (Name of individual sign'ing contract) ,e is,he .................. .............. ~' ' ' ' ' ' ' ' ' ' ' ' 'j (Contractor, agent, corporate eL leer, etc.) [ of said owner or owners, add is duiy authorized to perform or have perfon ned the said work and to make and file this application; that all statements conthined in this application are true to the >est of his knowledge and belief; and that the work will be performed in the mann6r set forth in the application filed there~ Sworn to before me this ............ /.,~ ........ dayo ND1ARY PUBLIC, State ol N~w Yor~ ../, ..... O'. ND 4707878, SuJfoJk COtlnty. ]'e m [Xpli'es March 30, ith. (Signature of applicant)