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Home My WebLink About20959-z ffO~v,~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~T.° 20§51 Z Permission is hereby granted to;,, . //. ........................................... ...... ..,:...,e.~....~...~..z....,~.. ................. at premises located at ...~....~..~....~......., County Tox Mop No, lO00 Section pursuant to appltcatio~dated .? Building Inspector. ~ " \ Rev. 6/30/80 I g./~..,R~,, and approved by the OUNDA'TION (1st) OUNDATION (2nd) OUGH FRAME & .PLUMBING 'NSULATION PER N. STATE ENERGY CODE FI:;AL ADDITIO COMME Examined ~ , 19 Disapproved a/c ..................................... -'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL OOUTHOLD, N.Y. 11971 TEL.: 765-1802 No. ~..~. ~...~...~ Received ........... ,19... 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 bef~)re issuance of Building Permit. d. Upon approval of tltis application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall 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 · shall have been granted by the Building Inspector. ~PPLICATION 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 necessary inspections. (Signature of applicant, or name, if a corporation) !.O. ©.q ............... State whether applicant i~owne.~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Namo of owner of premises . .~..~. iff. ~ ..... . .~.': . . .~.( .,':.~. ........................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) .. ~,~ Builder's License No .................... ...~ Plumber's License No ................ .X~?.... Electrician's License No ....... Other Trade's License No~/:/q.(O~.'Xf. C~ .............. 1. Location of land on which pr~oposed work will be done .................................................. House Number Street Hamlet /Ot~, ~.~ County Tax Map No. 1000 Section.. [ .~...~..~. ........ Block .[.[ .~..~..{ .......... Lot ~ ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ................... 3. Nature of work (check which a~plicable): New Building .... ': 'Addition~ Alteration ',.,. R pai Rem? al Demoliti'' 'J~l~.O.Ir~'.' ...... e r .............. v .............. on .... Other ...... · ............. Fee . . [ <' (to be paid on filing this application) 5. If dwelling, number of dwelling!umts ............... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ........ 6. If business, commercial or mixed occupancy specff¥~nature and extent of each tyne ~f 7. Dunens~o~.ns of existing structures, if any: Fron ... R~u~ ~ height .-~.[. ........... Number of Stories. :(-~ .......................... ~ ............ 4. t ...... Dimensions.of san~e structure with alterations or additjons: Front ......... ~ .~.'~.'... Rear... ll/~.'.O. ....... Depth ......--'~...[ ........... i'" Height .... .~l.--., ......... Numbex Of ~tories.."'/~. ...... -'~ .~- I ..... "$. Dimensions of e~tire new construction: Front ...... ~ [ ...... Rear ....~...~ ....... Depth ...r/, .~, ...... Height ....~. [ ..... N:_,nbe, of Ston'~s { , .... . ,.. /l' i"~'.,,'," F .......... '},' t"'t '~.a ....................... , .~ .,, { .......... 9. ;~lZe 9! lot. vront ...... iL,..'Pi? ........... Rear ..... l.t/..(~. ........... Depth ....~ .~,~ ........ 10. Dat~ of Purchase ......... , . . "; a Name of Form~- ,-, .... " 11.' ] ............ 0, ,-,w.~ ............................ Zone or use district in which pr~mises are situated..~{'{ ............. : ..... , ............................ 12. Does proposed construction violate any zoning la.~or, dinance or regulation: ~'~J~. ....................... 13. `w'i~tbe~`regraded~3?~j~.T.[.~A~...~.f.~..~...wi~ex~s~berem~vedfr~mpremises: __ Yes {No) 14. lname°fuwner°fPt:ergis-ei.~[["7~.~.,~, ..~.. Address .~--~' ~h,,,~',, Name of Architect .~.[J..'~.~ .~..~.[}.~..~. ...... Addres~.~.'..~.ait~l'dOl~[~2 ~}~i~':~:.'t~t-i~'"~'~ Name of Contractor..l~g~3.~..~-.C.'[I~... Addres;':i: ...... i i iiii~[;~; PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from proper~y lines. Give street and block .number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~ YORK, ............................. : .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... i .............. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 mm~ne~ set forth in the application filed therewith. Sworn to before me this otary Puhlio ...... ,% .fi:..q t: .......................... ,County /OovOe¥ ?O~t..rc. ~y l~u'o~. $:#e of It~v Y~ ........... ',..