Loading...
HomeMy WebLinkAbout11426-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, K Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF'THE WORK AUTHORIZED) N� 11426 Z Date .....TU.�, ...�..C�. ............... 19 A/ Permission is hereby granted to: > 00 ........ ..... .,�„ .....� �................ ...... : � : . . .-...,1).-�............. 5 c.�" I to ......... ...4%...Z:.��....... ........................................... ....... r�...�ft....... ..... .C..s , : . . of premises located at lr�.® . ........./../.l✓ :.7 .. ...........`:f✓ .:� .` :•. •• .... .... r � ... ...... ....... ..... .. ........... . ............................ ... ..... ........... ..... ..... .... ................. ....... ....... ... . .. ... .. .......... . ..... ................ .7.,?.......................... .. Cr%`�?..: ..: ... County Tax Map No. 1000 Section .... J.-7.c?..... Block .. a........... Lot No. 0-1 ............. pursuant to application dated .........15........... 19.01, and approved by the Building Inspector. Fee $.1....®.^........ � e ........ ................ .. ......................... Building Inspector Rev. 6/30/80 FIELD INSPEC,--=bN . DATE 11 COMMENTS —_ FOUNDATION ( 1st ). � y FOUNDATION ( 2nd ) 2 . z o �o ROUGH FRAME & c PLUMBING � h y t � INSULATION PER N . Y . y STATE ENERGY BODE x `k4 0 Leo\c7fi — FINAL (� ADDITIONAL COMMENTS : 1-1 A \H O • x y x 'd y FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined �. . . . ., 19�< Application No. ,oP . . . . . . . Approved . . . . . . ., 1�jPermit No.;ll.ell�e�? Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . .lG��� f'r. . . ., 19 . INSTRUCTIONS a. This application must be completely filled in'by typewriter or in ink and submitted in triplicate to the Buildi 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 strec. or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuance. of Building Permit. d. Upon appro-.,al of this application, the Building Inspector will issue a Building Permit to the applicant..Such pern 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name,/if a corporation) 16-jL1 (Mailing address of applicant). State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Name of owner of premises . . . �Gy J. .�r `. . . . .r a— �-� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No." . . . . . . . . . . Other Trade's License No. -, 1. Location of land on which proposed work will be done./ , . . 1. U W,,. . . . `���. . . . . . . . . . .// •. %/t.��.� �� . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . House Number Street Haml County Tax Map No. 1000 Section . . . . . . . .V.�� . . . . . Block . . . . . . . . . . . . . . . . Lot . . .1 . . . . . . . . . . . Subdivision . . . � : . . . . . . . . Filed I�iap No. . `�6. . . . . . . Lot . ... .. . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . .� . .�Jv.: �,� . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . b. Intended use and occupancy<:;'� 3. Nature of work (check whicl) applicable): New Building . . . . . . . . . . Addition . . '. . . . Alteration . . . . . . . . . . Repair� , Remo al . . Demolition . . . . Other Work . . . . . . . . . . . . . . . �. .� ��- �Z.�✓�c� .-c� q. CG Lc of ) (Description)- Estimated Cost . . . . . . . ._.. .. . . :-T . . . . . . . . . . . . . . . . . . ... Fee /.0. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . �. Dimensions of existing structures, if any: Front . ?? �� . . . . Rear . . . . . .- . . . . . Depth . . . ' . . . . . . Height . . . . . .f . . . . . Number of Stories . .�.P�' ' .®. . . .. . . . . . . . . . . . . . Dimensions of same structure with alterations or additio s: Fron . . . . . . .aZ?. . . . . . . Re r . . �% . . . . . . . . Depth . . . . . . . . ..3x . . . . . . . . . Height . . . . . . ./7. . . . . . . . . . . Number of Stories . `-4,✓ 3. Dimensions of entire new construction: Front . . . . . . . . . . ./: . . . Rear . . . . . . . ... . . . . . . Depth . . .1. , . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . ... . . ). Size of lot: Front . . . . . . . . . ... . .. . . . . ... ... Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . ). Date of Purchase . . . . Name of Former Owner ` � . . . : . . . . . . . . . 1. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . �. . ./ `. . . . . . . ... �,. . . . . . . . . . . . . . ?. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . 3. Will lot be regraded . . . . . . . . . .•. . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: Yes No 1. Name of-Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . ... . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :tenor or corner lot. '1�'i`I Li T� SN�D A�rTaG KEU To 9V-AR OF Ir.t'IsT. $/QeAcjt= Ga2u�j/}i�� Fisr��it-ws5 C��dF -Wuob- cv- FteC-pGLN 3as J �ICIMr1Cj 3i_�•� 1 qj 35 IRKI6T 1 C!TILI"!'� 714b - ' qAPACC--� Liz eL ►i _I — - - t� cal `_ �Lo 1 , sO l TATE OF ICE Y R T �r , OUNTY O S l TTt~K ZoICC L�4 NE . . . Jam. . -�!. . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual sign ng contract) )ove named. eis the . . . . . . . . . . . . . . . ... . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ?plication; that all stateme;its contained in this application are true to the best of his knowledge and belief;and that the •ork will be performed in the manner set forth in the application filed therewith. worn to before me this . . . . . . . . . . . . . . . . . .day of. . . . . . . . . . . . . .. 19 o Public, County ) IZABETH.ANN NEVILLE • • • • • • • • • • • • .. , .• • . ... . . `"` . . . . . dOTARY PUBLIC, ;state of New York (Signature of applicant) No. 52_8125850, Suffolk Cou ,