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Home My WebLink About14005-zTOV/N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 14005 Z Permission is hereby granted to: ....... .:..z;'.~..~.~....,~_,~c~.~..Z.~.~.. ......... ....... ~7~.~ ~.= ~.~......//~.~./ .... ,.~~Z ....... ,~z.¢....Z~.....]~ ........ ~.z~..Z.~ ..... ...~z~z~.~ ............ ~, ............. ot premises I~*t t ........ .~.~ .... ~ ............................................. County Tax Map No, 1000 Section ,,.,~.,,~. ....... Block ...~...(~... ......... Lot No.C~,~.~..-~.. ......... ~u~e~t ,o o~p,,~a,on doted ......... ~.~S~....../..~. .................. .1~2~Tond opp~o~ by ,h~ Building Inspector. .e. ,../...~.~ Building Inspector Rev. 6/30/80 ELD °'T N SP'RCT i ON COMMI,N 1 ~1 FOUNDATION___~ (2nd) I~OUGH FRAME & PLUMBING 3. INSULATION PEN N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ·OWN .ALL r~LDG. DEPT, ~ ~ , SOUTHOLD, N.Y. 11971 ~VN OF ,8OU~HO~ TEL.: 765-1803 Examined~. ...... , 19 . · · ~ Received ........... ....... Disapproved a/c~ .............. ;m . . . .~] .......... .a~.. ........ .r ...... ......... ........ ...... APPLICATION FOR BUILDING PERMIT 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 on the premises available for inspection throug~aout 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 the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessayf~oectio~,s, ' - ../.z. . . . . : . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owtker, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pre,niece...~...~.~...~e. ........................................................... (as on the ~ roll or latest deed) If applic~orporatign, signature of duly ~!&thorized officer. (Nt/me and title of c45Fl~rate officer) Builder's License No...c:~..7 ............... , ~ PlumbersLicenseNo...[.~r....~..~ Electrician's License No ....... ~ ............... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ....... ............ ..... ................ ................ House Number Street Hamlet County Tax Map No. 1000 Section .... 5.~.' .......... Block .... ~ .......... Lot. ,~.. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .............. '/~'~'' ?'~'~ ......................... / 3. Nature of work (check which a~plicable): New Building ... * . Addition ......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ...................... Fee ............................. i . ~: ;. , j q' (to be paid on filing this application) 5. If dwelling, number of dwellin~ 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 ..................... 7. Dtmens~ons of mst~ng structures ffany: Front ............... Rear ............. th Height ............... Number of Stories ....... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... i... Height ...................... Number of Stories ...................... 8. Dimensions of entire new consiruction: Front . . . ~. t£ ....... Rear .... /t~ ........ .h 9. Size of lot: Front .......... 1 ............ Rear ...................... Depth ...................... 10. Date 0fPurchase . · ......... ~ ................... Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed onstruct~on v~olate any zomng law, ordinance or regulation: ................................ 14.13. Will lot be regraded ....... ~l~2'h'~f.~4 ........... Will excess fill be removed from premises:.~,_ ,~sY s NameofOwnerofpremises ,,~rv~ ............ Address ...... PhoneNo .~.?.~4.'. ........... 7 Name of Architect .../~-)..!.~ .... ~ ........ Address.i.i ..... i iiiiii.ilPhone Nameof Contractor ~ .~/~ ....... Address ................. Phone No : ~t~..~'.'~-J~.~..'~__ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and bloc} number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I S.S COUNTY OF ' ............................ i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigOing 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 con~ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannpr set forth in the application filed therewith. Sworn to before me this Nbtary Public,.../~-A:~5...... ~..~.~. ........... Count ...... HELEN K DE VOE ..... . ................................ NOTARY PUBLIC, State 0f New Y0rl (Signature of applicant) No. 4707878, Suffolk]County Term Expires Marc 3~0, J. H. GEIDEMAN NEW YORK F~.D.I,U, 4 ZZ~,/ q .... , o.s /./',Em FPR,~