The URL can be used to link to this page

Home My WebLink About14272-z i~OB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 14272 Z Permission Is hereby granted to: .......... ~-.~,,.~...~.~.! ....... ~...~:..~ ..................................... ,o..~: ......... ..~...,~I¥~~...~....~.....~..~....~ ........... ~ ............. ........................... ~ ......................... : ......... ; ....... ~\ ........ ~..,,,,,~..;..y ........................ at premises located at ..1..~ ............. .~.~.~.......~4~... ................... ~ ....................... · ~ Q(~ o 3-- County Tax Map No. 1000 Sechon .......... ~ ....... Block ...................... Lot N ......................... .............................................~ '~..~ , 19~.~...,'"" and approved by the pursuant to application dated ._.........~,41~'~r~ Building Inspector· Rev. 6/30/80 'OUNDATION ( 1 st) COMMENTS OUNDATION 12nd) OUGH FRAME & FLUMBING NsULATION PER No STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ;xamined ~.~ .~..- '"-* ' .J..'~.., 191{. (. Permit No..l.c] .~. ?.2. ~ ~pproved )isapproved a/c ..................................... ............................... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Is 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 o~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cfition. 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 pern).it all 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 all 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 dlding Zone Ordinance of tlie Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the constraction of buildings, additions or alterations, or for removal or demolition, as herein described. te applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary insl;~'c~tions. (Signature of applicant, or name, if a corporation) (Mailing address, of applicant) S~ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / ~ame of owner o f premises .... . .%~..~....~. ..... .~..' .Q~.d..~..D.~'../0. e.~..Z~. ...................................... ~ (as on the tax roll or latest deed) I~ applicant is a corporation, signature of duly authorized officer. Builder's License No../.~...--~...¢.G.q. ........... Plumber's License No ......................... lectnc~an s L~cense No. Other Trade's License No .......... .-,. .......... Location of land on which proposed work will be done..~.,4..5f.. '.~..,~... ~. G~.,I./.zg. ......... .k'../ff~...~r'/2~...~ .7.,,7..P'' ~..~.. .~./.&-/f .7 .//0o5~5.. . ........ .................... - .. House Number Street Hamlet County Tax Map No. 1000 Section ...... .O.'7.~? ........ Block ff_o Lot ~ Subdivision .,~..~.kO..h-..~..O.~.T../v(oJ..qo.~...~.~.F. r4:.T.~.. ...... Filed Map No. ...'~. G..7.~.~ ..... Lot ... ~ ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... [.~.~../.m.../~.. ~G.~..g.g.g.g.g.g.g.g.g.~..(~ ............................................. b. Intended use and occupancy ..../~..~. G( .D.~..(~. ........ .o4./ .~G..~..'~.../..xy.~.~'?q.~..w.~...~../.,~../~..~w?.-..,~.,~..d-....a J/5(../.. ~ / Co D~ 3. NatUre of~work (check Which.~ppiicable): New Building ..... ' .....'Addition .......... Alteration .......... Rep~r ............... Rin~(~v~l .............. Demolition ............. Other Work//U..fc~,p.c& ./~.../~.o.O.& i~~ ,C~.os~t.C~,,~,~i~· ": -" ~ (Description) "" (to be paid on filing this application) 5. If dw611ing, numb6~ O{dwellingi units ............... Number of dwelling units on each floor If garage, number of cars .... i ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories., ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth. .................. !.. Height ......... , ............ Number of Stories ...................... 8. Dimensions of entire new construction: Front .~.~. ~.fi(./~ ...... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...... /. f./. i .'?.~i'f ...... Rear.. ~.~0.,..~./../ .......... Depth . .~:..¢.~.: ?./. ............ 10. Date of Purehase .......... [ .................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .....,3-~o. .......................... 13. Will lot be regraded .~/..'~ ...,,. i ......-. ............ Will excess fill be removed from premises: Yes~' No 14. Name of Owner of premises ~.,~p...~F..3~./d?.~?.~.m..~.e~. Address .~'q~..z/.~ .~..~W...'~..~ ..... Phone No..W~..-?:-.. Nmne of Architect ......... ; ................. Address ................... Phone No ................ Name of Contractor .S.~./.,:q. · ~(i .~.../'qqq~. .........Address .z/:7/./~.7.~zF..~..~o.q~.~.P.F. Phone No..7~. ?.~/.o. ?. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF...-~.o..~....~r~. ..... .............. . .~...Zr...S'~.. 7-..~ .~f~. ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 mannep set forth in the application filed therewith. Sworn to before me this ............ .~../...,a~.. .... day ofl...~:,~.~V/.,.t .~-'.. ........19 Notary Public .................. ,:..&f .~f/.d:.' ..... County //~ ~ Natal Publlc,-<;ta~(~ofNoWY' ' ~ ...... ~.d~. ~.~,y~.r&l_;~.~4ex. ........ eoIa llCant Oual ficd ir~ ,}ti,folk (,ou[?t , [~lgyR~g4lTe OI appllC )