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Home My WebLink About14115-z FOB~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAIL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 14115 Z Permission is hereby 9ronted to: , r-, /'~ .~.~....~.~.....~.~.....~.: .............. .~.,o***.~,....~ 2..~. ............................................... ,o ...~~.....~.'..~ '.g..~..~.~...~.....~. ~ ~ et p~eml.s ,oca~ed at...~S~.~.......I...~......~.~.~.....~..'. ...... ~~ ............. Co~n~ To× Map No. lO00 Section ....~..q...5 ........ B~ock ..... ~...~. ........ Lot No ....... L...q. ........... pursuant to application dated ....... ....~..~.......'~... .................. , ,0.~..s.~.., and approved by the Building Inspector. Building I~pector Rev. 6/30/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined · ....~. ]~.~ .... , 19~.~ Approved .~..., 19~.(. Permit No.. ~ ~..I.I..~..~.. Disapproved a/c ..................................... .... BLDg.. ~~''~ TOWN O~' ~OUI~OLD Rece±ved ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... 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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized insl3ecto;s on prendses and-in buitd~g fcr ~ecessaD, inspections. · 7. .W :d.. C°. ¢/c....~.4-.~. ~..~7 f..~.~. :(..~.~.~.~/./c./.,~ (Signature of applicant, or name, if a corporation) ¢?//3..-75 ........... (Mailing address of applicant) If applicant is a corporation, s.ignature of duly authorized officer. ......... (Name and title of corporate officer) Builder's License No .... ~ .C ................ Plumber's License No ......................... Electrician's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general con~ractor, electrician, plumber or builder· ................... t~ ............... A~7'Y~f'~'~ AS NOTED Name of owner of premises (~/¢ ..... ~. ...... ~ .......................... (as on the tax roll or FEE: ~'.~' BY: V 4'Z' NO-fZl-~;,r:' '~L]-II.-'[~'i-NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNr3A'TION - TWO REQUIRED FOR POURED CONCRETE .2. ROUGH - FRAMING & PLUMBING 3. INSULA'%ON 4. FINAL - CON'STDUCTION MUST, ALL CONSTRtJC'FION SHALL MEET THE REOJ R~ McNTS OF THE N.Y. Other Trade's License No ...................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done ................... dE'S'IGN O'R' C~RSTROCTION · .... .................. ........................... ........... f ......... a[C~reet Hamlet House Number County Tax Map No. 1000 Section . .?.?. ........ Block .... ~.~. ........... Lot..../..~. ............ Filed Map No .............. Lot ............... Subdivision ..................................... ' (Name) 2. 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 .................................................................... ~"g/~,;..>,~ · Nature of work (check which applicable): Repair .............. Removal .... Estimated Cost Fee .. If dwelhng, number~of dwelhng umts ............... Number of dx~ If garage number of cars If business, commercial or mixed occupancy, specify nature and extent Dimensions of existing structures, if any: Front ............... Rear Height ............... Number of Stories .................... Dimensions of same structure with alterations or additions: Front .... pth Dunenslons of entire new constructton: Front ............... Rear New Building ..... ......... Demolition ... dition .......... Alteration / .......... Other Work..../~..~..~.C.~'. .... .q2 0'2) (Description) (to be paid on filing this application) 'Jling units on each floor ................ .f each type of use .................... .............. Depth ............... ............. Rear .................. umber of Stories ...................... ............... Depth ............... 10. 11. 12. Does proposed construction vidlate any zoning law, ordinance or regulat 13. Will lot be regraded ............................ Will excess fill 14. Name of Owner of premises ¢~.e.~..g:~>.~.¢~.e.~ ...... Address . .~.~.~r Name :of Architect ........................... Address ...... Name of Contractor ........ ~ .................. Address ...... Height ............... Nuraber of Stories ........................................................ Size of lot: Front .......... ' ............ Rear ...................... Depth ..... ................ Date of Purchase .......... . ................... Name of Formez Owner ........................... ' i Zone or use district in which premises are situated ..................................................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or propose property lines. Give street and block number or description according to deei interior or corner lot. being duly sv STATE OF NEW YORK, I COUNTY OF ........... ...... ! S.S (Name of individual sigging contract) above named, i ,e removed from premises: Yes No ·.. Phone No. 7.~ ....... 7. ;L~;/~ ...... ............ Phone No ................ ............ Phone No ................ d, and. indicate all set-back dimensions from and show names and indicate whether He is the ..................... i (Contractor, agent, corporate of of said owner or owners, and is duiy authorized to perform or have perfor application; that all statements contained in this application are true to the work will be performed in the manner set forth in the application filed there~ Sworn to before me this 'ora, deposes and says that he is the applicant "' NOTARY PUBLIC, Stat~ of New York ' · ~, ~ ........ i · .'. · No. 4707878 8ull01k County ~ ~ (Signature of appl,!cant) lmm Ex~,re~ lcer, etc.) ned the said work and to make and file this 3est of his knowledge and belief; and that the ith.