The URL can be used to link to this page

Home My WebLink About17387-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL Permission is hereby granted to: ~ .................................. ~.~ ........ .~..:? ....... ,o .o.u~....~..~&.~...~-~....~...~..~..~.~..~ · , ~ /~ ~ ~~....~....~;~~....~...~ ............ ~ ........ ~ .................. , .......... County Tax Map No. 1000 Section ...... ..~....~....ZS. ..... Block ..... .C~....~... ........ Lot No ..... .C~..~... .......... pursuant to application dated ....~..c~..~....4~... ............. 19.~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 lrOR~ NO. ~ TO~A~N O~ $OUTHOI. D BUll~DING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEP~IT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15318 Z Permission is hereby granted to: .... ~..?..~. ............... ~..~ ......... ~ ...................................... :..~% ............... : ...... : ....... r~........i....,,~......z...~ ............ at premises located at ..I...~...~..~.~..~-.,..~ ........ d~..~;~'.Y-..../.../'..~~ County Tax Map No. 1000 Section ...... ..O......~:....'~.._.., Block ....... ..(~......~'... .... Lot No......O.....~ ............ pursuant to application dated .....,.,~.~....~....~...~..'~.. ......... , 19.?..,~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD %NSPECTION COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examined .~.~)t~-~.~.~., 19 ~.~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved~.. ~..~.~., 19 $.~. Permit No. l .~'.~ .~..~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUI LDING PERN1 IT TOWN OF gOUTHOLD Received ........... ,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 p~blic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of flfi,s, 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 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. APPLICATION IS HEREBY M~DE 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,/~sing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspection~ (Signature of applicant, or name, if a corporation) 7z ? ..... ....... ...,r. (mailing address of applic~'5 ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.. ~/~..~..~./..~...~..o..~. ....................................... (as on the tax roll er 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. /'~'~-~- Electrician's,License House Number Street Hamlet County Tax Map No. 1000 Section .--..q<. ~.~..."~'....~.. · · Block .................. Lot ................... Subdivision ' Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing and occupancy ........... / ........... }.. · ............ b. Intended use and occupancy ........................................... ~'.,.~ .'*,,~: ~' .,,I..':. ~. ,*?~,... ,,.;.. ...... 3. Nature of work (check which gpplicable): New Building .......... ~ddition .......... Alteration.. ......... Repair ......... ~..~Removai .............. Demolition . I~fi . . Other Work ............... .' ' 136 i . (Description) 4. Estimated Cost /. ~..'~.. ................... Fee ..~ ............................. i ~.. (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............ Number of dwelling units on each floor...~. ........ 6. If business, commercial or miied occupancy, specify nsture an~ extent of each type of use . 7. Dnnenmons of~ex~mng structures, if any: Front. ,g'.~..-¢. ~. g.~.~. Rear . $~/..~. ....... Depth . ~ .-:. ~. ....... Dimensions of sam~'f(r~cture With alterations or additions: Front .. /?],.~...9 ....... Rear.../~. ~. ......... Depth../. ~../.--~. .......... [.., Height.. ~..~ .~. ............. I~umber of Stories... ~Tqt,~. ~.. ......... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............. ,.. Number of Stories ............. ~ ........................ ! .... Size of lot: Front . ~.~.-~.~'. ~//.. .......... Rear .... ~.~. ~ ........... De~th . .'~.7_~.~.~..~. ........... 10. Date of Purchase ....... .7../.. ~.;~. ............ Name of Former O. wner .. ..... 11. Zone or use district in which/premises are situated.. ~_~~ ......................... 12. Doesproposedconstruct~onvlo. late any zomng law, ordlnanceor.regulatlon: ...~ ................ 13. Will lot be regraded ...... _/~.,., ................ Will excess fill be removed from premises~/ta-$~s' '~ '[N~' 14. Name of Owner of premises . ~r. ~..PI~...~. ..... Address j~*-~m~. ~'~-.. Phone No..SP. ).'?. Nme of Architect ........ i .... r~ ............. Address ...... -~ ............ Phone No....~ ............ Name of Contractor .... ~r~)~. ~ ............ Address ...... ,¢7~.~_... Phone No. 15. Is this property located withintiO0 feet of a tidal wetland? * Yes ~" · If~yes, Southold Town Teustees Permit may be required. PLOT DIAGRAM '~Locate 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. STATE OF NEW YORK, S.S .... ..... ...~..~. ?./. ~ .... .~J../..~.~..~..c?y....! ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the...~.F~</..'~..~/~. ........ ................................................................. of said owner or owners, and is drily 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 manner set forth in the application filed therewith. Sworn to before me this 19 4 ................. day , ...... tlNDg J_. CO0 .- . .~/ ........... i~iln;;ure o f appli;~ti , Not~ Publlo, Stile ~ New No. 482256r~, Suffolk CountY~ Term Expires December 31,