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Home My WebLink About14275-z l~Olt~ NO. ~ TO~N OP $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 14275 Z Permission is hereby granted to: .~.~?...~....~....~~... .~.~...~..~.~.~..~..~ ............... .G.~..~:~....u~ .... . -~-~.~....~ ............................... ,o ............... at premises located at ............................................................................................................................ County Tax Map No. 1000 Sec~o~.....C~...,~.,~.'~.... Block ..... ..~...~.. ...... Lot No ....... ~....~. ........... pursuant to application dated ~.,..'~......~..........~....~. ............... , 19.~....~.?., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180'3 ~pproved . .~...-~...~...J..~'., 198..~. Permit No. : ' Vr8¢¢ , OF )isapproYed 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 ts 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 : areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- trion. 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 tail 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 tall have been granted by the Building Inspector. ihAPPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e 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 inspections. , ..... .77./q ¢.~../.~.-~-¢ ~-./¢.../.~ .,4~.~.. ff..q .............. (Signature of applicant, or name, if a corporation) .... .... ......... (Mailing address of applicant) ',tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 4amc of owner of premises . .~..~'..~...t~./~.~../~.~.,~ ~....~. 7tq~ze,~~. ..................................... (as on the tax roll or latest deed) If a_p~t is a 8orpor~signature of duiY authorized °fficer. (Name and title of corporate officer) Builder's License No ...... ~.~...~ · ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. o '£0 ..D..x.... f4 House Number Street Hamlet County Tax Map No. 1000 Section '~' Block ...q'~......~..? ...... Lot ~ /~ Subdivision . . . ~[¢.q ~.~>... /p ~. ..... Filed Map No..q.~ ....... 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 ......................................... [~1~.¢, ......... · ' .... ' ........... 11. 12. 13. .-7i4. 3. ature of~ work (check which applicable): New Building .......... Addition .......... Alteration a .......... ~,~ .1~.. it , . _ 'emoval ............ Demolition . . . OtherWork .... t~ . ................ ....... ................. ~! 1~} ~8~ ~)~' ' ~' (to be paid on filing this ap;l~iti;n) 5.' ~ dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ If gafa~e~ number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure With alterations or additions: Front ................. Rear .................. Depth .................. ~.:... HeiSt ...................... Number of Stories ...................... ~' 8. D~ensions of entire new construction: Front ............... Rear ............... Depth ............... eight ............... Number of Stories ........................................................ Size of lot: Front ...... ( ?. 9 ............ Rear ..... ~ .............. Depth .. (2 / ............... Date of Purchase .......... : ................... Name of Foyer Owner ........................... ' Zone or use district in which p~emises are situated ..................................................... Does proposed construction viglate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ [ ......... ¢ .......... Will excess fill be removed from premises: Yes No Nme of Owner of premises ~-~7~/~.~ ........ Address O.~..6<q<~o~. Phon~ No. ~72 r.. 9.q~.~. Nme of Architect ......... ~ .................. Address ................... Phone No ................ Nme of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM 1,ocate clearly and distinctly all buildings, whether existing or proposed, and~indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. i , II STATE OF NEW YORK, COUNTY OF ................. APPROVED AS NOTED ~fi:,,~:~' By:_~/. ~'.L. ~OTIFY BUILDING DEPARTMENT AT ~65-1802 9 AM TO 4 PM FOR THE 'OLLOWING INSPECTIONS: ~ FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2 ROUGH FRAMING & PLUMBING ~. INSULATION ,~. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.G. ALL CONSTRUCTION SHALL MEET rUE REQUIP~MENTS OF THE N.Y S~ATE CONSTHUCTION & ENERGY CODES, NOT RESPONSIBLE FOR ')ESIGN OR CONST~IUCTION E~,RORS, i S.S ....... ~;/, .~P..~ ..... .~.-. · · .'~.~+.2.rl .e~..'g.: ~. .............. being duly sworn, deposes and says that he is the applicant (Name ..... of mdiwdual s~gnmg 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 cont:ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannqr set forth in the application filed therewith. Sworn to before me this ............ c~ ~ ~ day oi Notary Public, .......... County NOtA~ ~Bl.~ ~l~*m~ ~ ! .... "'" ............................. No, 4?0?8?8, ~ell~ ~111~ ~- ~ (Signature of applicant) Term Expires Ma~h 30, IL,,,~ ( ,