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HomeMy WebLinkAbout11609-Z FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N©. 116fl9 7_ Date ............................... 19. Permission is hereby granted to: A ~ , ...... .... .... zf.,Z..~.-....'~'~,,,z..~.~./.~.~...,,.~.~. ...~.a~./~/.~..,......~..:.~..:. ........ zz~.Z/... , o . . . . . .~. . . . ~. ~ z'A. .~. ¢. . . ~ ....... . ~. '. . = ~. .'. . ...... ./.z ~.~. ./(,. . . . . . .~. ~. ,~. ~. . ......................................... at premises located at. ..~L ....m~..~..~'~.A~.,~'..~--_~. ~.. ....................................... ......................................................................................................... ....... Counw Tax Map No. 1000 Section ..O~ ........ Bilk ....O~ .......... Lot No...~Z~ .......... pursuant to application dat~ ...... ~~ ....... ~......, 19~and approv~ by the Building Inspector. Rev. 6/30/80 FIELD I PECTI0N JIDATE 11 COMMENTS 'Tl 1 . H CI FOUNDATION ( 1st ). • x� FOUNDATION ( 2nd ) _ n 2 . �O ROUGH FRAME & PLUMBING ' y r� INSULATION PER N . Y. y STATE ENERGY CSODE x r FINAL 0 ADDITIONAL COMMENTS : per S H i F-7 H ' O �f Z V " x • r y x d r� FORM NO. 1 - T0VJ%J G; S0UT:;OL.D BUILDING DEPARTiMENT TOWN HALL SOUTHOLD, N.Y. 11971 / TEL.: 765-1302 / Exaitiine . . . . •. 1 App lication No: � • / . . . . . . Approved, //. . . . 1., 1`:Permit No. Disapprovcda/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 (Bui di g Inspector) APPLICATION FOR BUILDING PERMIT ]j Date !.�. e: . .��.'! . . . ., Is& INSTRUCTIONS a. This application must be completely filled ill by typewriter or in ink and submitted in triplicate to the Buildir Inspector, witli 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plansliowing location of lot and of buildings on premises, relationship to adjoining premises or public strei3 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of'this appi cation. c. The work covered_ by this application may not be commenced before issuance of Building Permit. d. Upon apprc-,al of this application, the Building Inspector will issue a Building Permit to the applicant. Such peni 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 Oecupane shall have been granted by the 131.1ilding Inspector. APPLICATION 1S HEREBY (MADE to the Building Department for the issuance of a Building Permit pursuant to t4 Buildin; 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 describer The applicant a;rees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit autliorizcd inspectors on pi•ernises and in buildings for necessary inspections. - • f :I. dti'. . . . . . . ... . . . . . . . . . (Signature of licant, or name, if a corporation) address of applicant) State whether app'icant is owner, lessee, agent, arc'iitect, engineer, general contractor, electrician, plumber or build,-. \'tine of owner of pr:noses . . . . . . . .. . . . • . 1:�-! . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. : (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Naine and title of corporate o icer) Builder's License No. . • • • • , , , , , , , . Plumber's License N . . . . . . . . . . . . ... . . . . . . . . . . . Electrician's License No.: Otlier Trade's License No. 1. Location of land on which proposed work will be done. yt'�vG;sue• • �Y ��1� • • . . • . , • _ . . . . . . . . . . . . . House Number Street Hamlef County Tax Alap No. 1000 Section . . . 1. . . . . . . • • . . . Block . I . ��. . . . . Lot . . li�. . . . . . . . . . . . . Subdivision . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed MapN (Name) o. . Lot . ... . . . . . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . • • • /,r;Uc{� �e..N• r ,' • _ , . . . . . . _ . b. Intended use and occupancy �... •-� .."_ .., , aK.,•„ ,,.:" "'tea - ., _ 116 zf 3. Nature of work (check whic!, applicable): INCW BUildilIg . . . . . . . . . . Addition . . . . . . . . . . Alteration ... . . . . Repair . . . . . . ... . ... . ... Removal . . . . . . . . . . . . . . D=olitlon . . . . . . . . . . . . Other Work. . . . . . . . . . . . . . . --t- <2 (Description) Estimated Cost .'16.60. . .. . . ... . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, If number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on.eanch floor,. . . . . . . . . . . . . . . garage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. If business, colimci-cial or mixedxed occupancy, specify nature and extent of each type of use . . . . . . .15. . .epth. . . . . . . . . . . . . . . 7. Dimensions of existing strictures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . ... Height. . . . . . . . . . . . . . . . Number of Stories . . . . . . . D Dimensions of same structure with alterations or additions: Front . . . . . . Rear . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height Number of Stories . . . . . . . . . . . . . . . . . . S. Dimensions of entire ne,,'v construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . Height . . . . . . . . . ... . . . . Number of Stories . . . . . . . . . • 9. Siza of lot: Front Rear A . . . . . . . . . . . Depth . . . . . . . . . . 10. Date of Purchase: I.VA-,44 /T4 N rn . . . Name of Foier Owner . • . . . . . . . .. . ... . . . . . . Zone or use district in which premises are situated . . . 12. Does proposed construction violate any zoning law, ordi',i'ance*o*r're,,t*il*a*ti'o'n g 11 ':. . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . ... . . . . . . . . . . . . . . . . . Will excess 0 - -7 s fill be removed from premises: Yes • N J4. Name of Ov.-m r of premises . Address - P­6''1916*`1•l,�X -, ,,fib.,Phone No. e Name ofArchi[cct . . . . . : . . . . . . . . . . . . . . .I . . . ... . Address.. . . . . . . . . . . . . . . . Phone No. Name of Contractor . . . . . . . .. . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . .. . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whCther ,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 anterior or corner lot.. and indicate whether 41 /)� \V ATI- FPTATE OF NEW YORK, Op.',NTY OF S.S . .. . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Nanle ndi�iduil'sif,'?ning contract) ibov- named. -le is the . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.)* F snid owner Or OWiLfS, and is dLll%l authorized to perform or have performed the said work and to make and File this pplication; that all st-itcnients 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 iii the application filed ti,ercwitji. 'worn to before nic this . . . . . .dav of. . . . . . . . . . . . . . . . .. 19 fOtarY Public, OUTI'ty ,IVNota,y Pllbl;, , FERRY 03 63.". of ew y sl')�i . Su ti p ' Q1 (Signature of applicant) U