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HomeMy WebLinkAbout18811-z 1~ NO, · TO~N OF $OUT~LD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18811 Z Permission is hereby granted t · · / /~/ , ~ /~ , ..~.~...&..,-,,~. ~~..~.. .................................................. ........................................ County Tax Mop No. 1000 Section '~ '~ Block '~' Lot No. pursuant to application dated ......... ~../~. ................................ , 19.~....~., and approved by the Building Inspector. Rev. 6/30/80 [ BOARD OF HEALTH ........... 3 SETS OF PLANS ........... FORM NO. 1 SURVEY .................... TOWN OF SOUTHOLD CHECK ..................... BUILDING DEPARTMENT SEPTIC FORM ............... TOWN HALL .... ~OWN (~, ~OL~, ~OUTI4OLD, N.Y. 11971 NOTIFY: ~7 TEL.: 765-1802 CALL .... Examined ..... ....., Approved ........ . ....................... 766-1802 9 AM ~ 4 ~ FOR ~E (Bu~n~ector) FOLLOWING INSPEC~ONS'_ ~ ~ FO~UILDING 1. FOUNDATION - ~REQUIRE~PPLjCATI~ PERMIT FOR POURED CONCR~ D=Lc ................... ' 2. ROUGH - FRAMING & 3. INSU~TION INgTKU~IONS 4. FINAL CON~8U~N MU~ sets ~a~~ p~ ~a~vFee according to sckedula. ' ~e~~i~ and 0r huila~s on premises, relationship to adjoining premises or p~b~c street~ ot a~~'~~?T~ of layout of property must b~ drawn on th~ diagram whic~ d. Upon approval of this application, the Building Inspector w~l issued a Building Pe~it to th~ shali b~ kept on the premises ava~ahie ~or inspection throu~out the work. e. No bulldog shall b~ occupied or use~ in whol~ or in p~rt for a~y purpos~ wkatever until a shall Mv~ been granted by ~ Bugd~g Inspector. APPLICATION IS HEREBY MADE to th~ BulldOg Dep~ment for the issuanc~ of a ~ding Pe~it pu~uant to the ~uilding Zone Ordinanc~ of tke Town of Southold, Suffolk County', New Yor~, ~d other appHcabl~ ~ws, Ord~c~s or Regulations. fortg~ const~ction of bu~d~gs, additions or alterations, or for b~moval or demolition, as he~ d~scfibed. Th~ applicant a=ree~" to comply wire ali appJica~ laws. ordinances, bu~g cod~, housin~ co6~, admit authorized ~sp~cto~ on premises ~nd ~ bulldog for nectss~ ~sp~ction~. ~~' ? (S~gnature o~ apphcant, or name, if a corporn~zon) iMailing address of applic~t) ' ' State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises (as on the tax roll or latest deed) [£ applicant is a corporation, signature of duly authorized officer. Builder's License No...~ .......... ... · · Plumber's License No ' Electric'an s License No Other Trade's License No ........... · Location of land on which proposed work will be done: tIouse Number Street, Ham[ct Counw Tax M~p No I000 Section .... Bl¢ck Lot /~0t .d~... ~g.~ .............. ~ilcd Map No. ' Subdivision ....... ff~. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed consm~ction: a. Existing useand occupancy ......... [-~/Y-q (fi' ...........'' ---. .. '; " . b lnten~c~_ ~ us~ ' ~nd occupancy ' ' ' Nature of work (check which applicable): New Building Addition Alteration ..... Repai[s. ~;. ;[ ........ R~moval .............. Demolition .......... ~t .Swimrain~.~..~ ........ Term· u ~ ....... Accessory Building .......... Fence ....... 0ther 'Wo-rk; ........... ;. E$limaled Cost.. ~'..~.g?. ............................... Fee~-? ................................... (to be paid on filing this application} · Ifd fd tit it N fd Iii it ,. welling, numbero wc ngun s...../. .... .... . umbero we ngun soneach opt... .... ........ . If garaee number of cars 2- ....................................... i. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... r. Dimensions of existing structures il' any: Front Rear . . Depth Heieht ........ Number of Stories ................................ Dimensionsofsamestructurewithalterationsoradditions:Front................. Rear........o........' Depth ..................... . Height .................. ... '. Number pC Stories .... .. ............... . l- Dimensioas of entire new construction: Front ..... .~.~..~T .... Rear ... -~.$.~-~. ~ .. Depth . .7..~_.~T ....... Heieht. ............... Number. of Stories .............. : ............. .%..xj ........... t ......... ~):. Si.cc o£Iot: Front '~'~'~ ,, . o'...~ Date o£Purchase .~2. T../..~..~ .~. ................ Name of Former ©whet ........ ; ............ k: Zone or use district in which premises are situated ........................ a .... ~ ....... ' ................... ~ Docs proposed Construction violate any zoning taw, ordinance or regulation: . .~ .... 3. W~i lot be rcgmded ... ~4... ~ .................. Will exces~ fill be removed from premi~c~: Yes ~. N~e of Owner of premises ~Zy,i~j~¢{r~< .~.a~-Addrc~ .~2~(~q .... Phone No. Nme of Architect Addrc~ ~ ~ ' . ...... Phone No...%.~ ...... N~e of Contractor.......' ............ Addrem ....... ' we~Ian~- ~I~ 7es~ Southo~d To~n Iru~rees Permit may be requlred; PLOT DIAG~M Locate cle~17 ~d dist~ctly ~1 bufld~gs, whether existing or proposed, ~d.i~c¢[¢~'~¢[-kqek d~ons from rope~y ~ne*. Give street ~d block number or deschption accord~g to deed, ~d skow street nines ~d ~te whether ~tefior or comer~t. . ._ (' STATE OF NEW YORK, S.S COUNTY OF ................. ......................... being duly sworn, deposes and says that he ist~e applicant (Name of individual signing contract) above nam'cd. Ism is the ' ' - . (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to pc,florin or have performed the said work and to rnair~ and Hie this application; that all statements contained in this application are true to thc best of his knowledge and bclicf;~nd that thc work will bc performed ia the manner set forth in the application hied therewith. ' ;. S~vom to before me this i". ............ ..... day or .... .... :' .. ldo, 4707878. Suffo~ County ,~, ~ o f a pp '