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Home My WebLink About14276-z FOR,~ NO. 0 TOVtFN 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) No_ 14276 Z Permission is hereby gran~ ~ , . · ...... l.~ ....... ~ ................................ ...~..~.~.....~..~ ........ !....~..~ ................... ,o ~.~.....~..~ ......... .;~....~......~...~...~ ....... ~ ............... at premises located at .J...~.~.~......~.~..~....~.~~....~.. .................................... County Tax Map No. 1000 Section ..... ..~....~....~ ........ Block ...... .?..) ........... Lot No ...... !..~.. .............. pursuant to application dated .... ~.~.?.....~...~ ................ , 19.?..~.., and approved by the Bullding Inspector. Building Inspector Rev. 6/30/80 "~' FORI~ NO, 1 TOWN OF SOUTHOLD BU I LDING D EPARTM ENT TOWN HALL , ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 gxamined .......... !~.., 19 %pproved .c~. · .~27..~q. · .~.~., 19 ~.ff. Permit No.)..~..~..~.[~ ..~. )isapproved a/c ............. ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, DEPT TOWN OF Received ........... ,19... Date ................... 19... INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by tins 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 hall 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 ~ Certificate of Occupancy hall have been granted by the Building Inspector. mAPPLICATION IS HEREBY MADE tothe Building Department for me issuance of a Buitdjng, ,Pe.rmit pu,,rsu,.ant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appncame Laws, urumances or gulations, 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 it authorized inspectors on premises ~nd in building for ~ecessaryinspectiops. ~. . .............. (Signature of applicant, or name, if a corporation) . . . . . . .rd. u Js. . g . . / (Mailing address of applicant) ltate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Rgen+ ........................ ~ame of owner of premises .....r~.~.+...r~..~...~....~.~....~..~ ..................................... (as on the tax roll or latest deed) If app.,lica~t is a corporation, signature of duly authorized officer. (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 do;~e .................................................. ............ .... .... &zne ....... ............................ House Number Street Hamlet County Tax Map No. 1000 Section .... ?~. .......... Block ..... // ............ Lot..4.0 ............... 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 . b..Intended use and occupancy ....... ~: ................... ,*~q ~:-;~..'5i~":~ ~I~ ............ 3. Nature of Work (~h~]k'~'~[i~ applicable): New Building ..... Addition Alteration~ Repair ............. ~ R'emoval .............. Demolition .............. Other Work .. ~ .... 4. Estimated Cost ...~..~..~. ....... Fee .... ~..0.D. (Descriptio : *~ (to be paid on filing this application) 5. If dwelhng, number of dwell,ng umts ............... 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 ..................... 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 con4tmction: Front ............... Rear ............... Depth ............... Height , Ndmhe~ of ~to'q~ 9. i Size of lot: Front ......... i ............ Rear ...................... Depth ...................... 10 Date' of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does propos, efl construction viplate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ! .................... Will excess fill be removed fi,om premises: _ Yes No 14. Name of Owner of premises ~..~..ql.C~. .......... Address .I.~.c[~'.. J{enr,]~4..~ee0~CPhone No. '~.,.~q.; 7~i~O.~... Name of Architect ........ ~ .................. Address ................... Phone No ................ 'Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc interior or comer lot. APPROVED AS NOTED · .>4 --- -. V.d. FEE.- ' - ~Y: : .... NOTI~' BUILDING DEPARTMENT AT 766-1802 9 AM TO 4 PM ~R THE FOLLOWING INSPECTIONS: I FOUNDATION ~O REQUIRED FOR PO~ED CON~ETE 2. ROUGH FRAMING & PLUMBING 3, INSULATION 4, FINAL CO:qSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIP~MENTS OF THE N.Y STA~E CONSTRUCTION A ENERGY CODES. NOT ~SPONSIBLE FOR STATE OF NEW YORK, COUNTY OF ................ S.S number or description according to deed, and show street names and indicate whether /, ·..I .....i...Z.t.r~..o_.. ?'....O'_'_'_~.~.~t.t".tO ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· ! SHe is the i ~ .~..~.~O~. ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 manher set forth in the application filed therewith. Sworn to before me this .......... .~.( .......... da~f ...... ~ ......... 19 .~..?