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Home My WebLink About14146-zTO~N OP $OUTHOL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14146 Z Permission is hereby granted to: ......... ..~.~.~.~....~....~.~.~...~.: ........... ...... ~. ....... ~ ....... .~ ........... ; ........... ,..; ..................... , to ~ct' ~.~og~-o ..... ~ ....... .~...~ ......... ................................................... ~...~. ................. .¼ ..... ~ ~.~ premises located at ............................. . ~ ........ pursuant to application dated ........ ...~....~..J.~ ..................... , 19.~.,~:.., and approved by the Building Inspector. Fee $., ,~c~...~..~.. ;....~.. · ...... Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19~..~'7. ., 19'~.. Permit No. t .q.}..~.~. .~... Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG, DEPT. TOWN OF SOUTHOLD 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 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 tho construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, b.uilding cbde, housing code, and regulations, and to admit 'autkorized inspectors on premises and in building for necessary inspections. , · .. ;~i'i'~.l;):'~' .1: 'a'nt~'.'~;. ';;a'tio'x~.'''' t lgnaureo apple , , p ) : : (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .d ....................................... .4 ................................... ' .... '. ~ . - ' ' ' ~APPROVED A~ MOTED Nameofownerofpremises..~.':r~fk~..~.~ .~. · .~.'.~/x~_~,c'.~.TjT.~x~.J~-~-_ .......... ,. .................... ~ (as on theltax roll o~[ deed,/**J]f~,. If applicant is a corporation, signature of duly ahthorized officer. ~:.,~ ~ ',~ NOTI~ ~ILD~NG D~AmMENT AT (Name and title of co~orate officer) 7~-1802 9 AM TO 4 P~ ~R THE FOLLO~NG INSPEC Builder's License No. 1 FOUNDATION iM~ RL~,.U ~ED ........................ FOR PO~ED ~. ROUGH FRAMING & ~UMB~NG Plumber's License No ......................... ~. INSULATiON 4. F~NAL CO;qST~UCTION MUST Electrician's License No ....................... ~ COM~fiTE FOR C.O. ALL CONSTRU~TION Other Trade's License No ...................... TH~ REOUI~ME~TS OF ~E N.Y ~AT[ CONS~C'rlON ~ ~SGY 1. Location of land on which proposed work will be done. ~D~8. NOT ~8~N8~ F~ ......... .............. 9~I~N 'OR '~O~ga~ON ............... ............. C &:y e .................. House Number Street Hamlet County Tax Map No. 1000 Section (~.Z~ .... Block ....... ~.~. ........ Lot ..... ~ y.~ ......... 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... ~..¢~.~.4~~.~ .~ ........................... b. Intended use and occupancy ........... ~~ ..... ~l. ~~ ....................... Nature of work (check which tpplicable): New Building ..... ' ..... Rew t'['~ ..... Re,~ovai .............. Demolition . Estimated Cost /[/' .~. ~. ..................... Fe If dwelling, number of dwellin units ............... Number of d .ddition .......... Alteration .......... Other Work ~5~ (Description) (to be paid on filing this application) lelling units on each floor ................ 10. ,11. 12. 13. 14. If garage, number of cars ... ~ ................................................... usiness', commerc ...... If b iai or mix ed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Ret r ............... Depth ............... Height ............... Ngmber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. i · · · Height ...................... Number of Stories ...................... ,-' . 8. Dimensions of entire new construction: Front ............... Real ............... Depth ............... Height ............... NUmber of Stories .................. r ..................................... Size of lot: Front ......... i ............ Rear ...................... Depth ...................... Date of Purchase ......... , ................... Name of Fonm r Owner ............................. Zone or use district in which ~remises are situated ..................................................... Does proposed construction vilolate any zoning law, ordinance or regul, tion: ............. Will lot be regraded ....... , ............ . ........ Will excess fill Name of Owner of premises ~...q)(3.'.~:~..~q~.. Address Name of Architect ....... [ .................. ',3 Address ...... Name of Contractor ......................... Address ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo~ property lines. Give street and block number or description according to dee interior or corner lot. ..... - STATE OF NEW~ORK, ~ - - "it- -z~-:~ .... ,. ~'~ ~:~'~&~ · ,;. ................ being duly ' '. (Na~e of.individxM~nin~[¢¢ntract) above ~amed. be rem. ovid from premises: Yes .N.o .......... Phone No. -I..:5..q...~.~.c~ .r~.. . ........... Phone No ................ ........... Phone No ................ ed, and, indicate all set-back dimensions from ~, and show street names and indicate whether d D ~fi tc ) ~ uned the said work and to make and file this best of his knowledge and belief; and that the vith. application; that all statements contained in this application are true to th~ work will be performed in the manner set forth in the application filed there Sworn to before me this 1 ,., ........... 197~7 ry ' ~'. .... /~ ........ County He is the... , ,. -' '- (Contractor, agent, corporate o of said owner or owners, and is dOly authorized to perform or have perle ~orn, deposes and says that he is the applicant