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Home My WebLink About14243-zTO~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) N~ 14243 Z Permission is hereby granted to: ...... ~~....~.~.~ ...................... ! --. '~te ............ ~o ...... ~ ........................ ~.. ~~..,....~....~.~ ................ ~ ......... , ................................................ ., ,,,~,,, ,~.,ed ~, .~....~..~.~.~..~..,.,...:,.~.~.,.;,......,.,..,..~.~,.;~., .................... County Tax Map No. 1000 Section/~LO...~. .......... Block ........ .~. ........... Lot No .......~....~. ............ pursuant to application dated .......................... 19.~...~.., and approved by the Building Inspector. Building In.~ector Rev. 6/30/80 F~EL~ ~NS?ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME ?LUMBING iNSULATION PER N. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: Examined ..~. .......... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ., Approved....~..-~.., .[~...~.., 19~..~. Permit No. TOVChl OF $OUTHOLD Received ........... ,19... Disapproved a/c ..................................... . .., ........ (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 o~n 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 i shall Ix.ave b~er~ra~ted by the Building Inspector. APPi~t.Ce~)N! IS' HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~';(~id~nance Of the Town of Southold, Suffolk County, New York, and other applicable Laws, O. rdinanc.efi or : Regulations, fol'' the construction of buildings, additions or alterations, or for removal or demolition, as hereto described. · !The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ' iadmit authorized inspectors on premises and in building for necessary in~qctions. /f / , [ (Siggature of/applicant(/or name, if a corporation) I(Mailing ~dress of applicant) !State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. iN,me of owner of preraises. S...= ..... ........ } (as on the tax roll or latest deed) ilf applicant is a corporation, signature of duly authorized officer. (Name and title of co~ ~ra~te officer) Builder's License No ...... ~'~...~.0. .......... Plumber's License No ......................... Electncmn s L~cense o ....................... Other Trade's License No ...................... I. of land which proposed work will be done Location on House Number / Street Hamlet County Tax Map No. 1000 Section ....I.Q?. .......... Block ~ 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 ,.. r ....................... ,.. ......... , ................................ b. Intended use and occupancy ....... .'~.~ ~..,...~Ov..~.'.~..~. '.'=.~' .~.t~.. .......................... 10. 11., 12. 13. 14. [ ~! ,?a~ure.o~worl~.~ . . (check which applicable): New Building ..... ' ..... Addition .......... Alteration .. .~ .... ; ~ ~ Repair ...... ~, ....... Removal .............. Demolition .............. Other Work ............... "~ ~1~$' ~ (Description) 41 Estimated Cos e~ Fee ........ " ' ...... ~' (to be paid on filing this application) "If dweiling, 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 7Dimens!ons of existing structures, if any: Front Rear Depth Height ............... Number of Stones ........................................................ Dimension_~ of same structure with alterations or_additions: Front . .~('./,~,rz~l/-Rear .................. pth i 'ght -' De ...Z ................ Hel ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............ Rear .... Depth Height .......... Nhlm~er nf gtnri~ .................................................. Size of lot: Front i Rear Depth Date of Purchase Name of Former Owner Zone or 4se district m whlc., pre~mses are situated..,.... ................................................ Does p~oposed constructio.n violate any zoning law, ordinance or regulation: .... : ./~f.~ ....................... Will lot be regraded .....~'5'. 0. 4 ................... Will excess fill be removed from premises: Yes No Name of Owner of premises Address Phone No Name of A~chitect : Address Phone No Name of Co~tractor ..~¥,e~.K,/~.,f..~"~..~.~.'o ..... Address ~ .~.']'/J'/'t~,,~l .... Phone No. ~.~t~gi. ~.... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STA E OF NEW Y, ORK~ ~ S COUNTY OF..//,,ff. fm-~.'. 'i ~' ~' // ~~ n''~7'/~'///g cdntract) being duly sworn, deposes and says that he is the applicant ( i above named. ~ He is the ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is dhly authorized to perform or have perfumed the said work and to m~e ~d flY, his- application; that all statements co~tained ~ this application are true to the best of his knowledge and belief; and that the work wgl be performed in the m~her set forth in the application filed therewith. Swum to before me this i , N~8~ Public St~ oJJ N~ ~o~ · ~ ~ r ~.. c .... ~ .... ~../~... m ~ ................ No 52 9703725 Su~lk ~n~ ~ ~ (Signatur~ of applidant)