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Home My WebLink About11559-z TOWN OF BUILDING DEPARTM~N~ TOWN HALL $OuTHOLD, N'. BUll. DING. ~,ERMIT (THIS PERMIT MUST BE KEPT ON: THE PRE/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~ 15 5 9 Z ~ote ..~~....~....... ............. , Permission is hereby granted to: ~.~.....~.~.../.:¢ ,o ..:.....~.~?..~.....~.I~.~_.~.~..../.. .................. ; .............. ::...~: ................ ~ ........................................ .................................................................... ~':'":'"': ........... :"~'i~' ................ l'"'"; ...... ; .......................... o, p,em,se, ,ocated at ............... County Tax Map No. 1000 Sect,on ...~...~.~..,...: ..... Block (~ ......... .~.~. : ~Lot No..~..C~..~.....~.~ ... to application dated ~.. ;~ ~ 19~."~/and ; pursuant . ...,~...C,~...~..~..~.,.; ..... !,....., ~pproved by the Building I~spector. ~e~ ....~ ............... ; Building ~!nSPecta~ Rev. 6/30/80 ' : J i DATE COMMENTS ~nd) ADDITIONAL COMMENTS: FIELD INSPECTION 1. FOUNDATION ( FOUNDATION ( 2. ROUGH FRAME & PLUMBING 3. INSULATION FER N STATE ENERGY FINAL TOWN OF SOUTiqOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180::3 Examined . .r~..~..~.. ~. ...... , I Application No.././..D"~.J, ......... Disapproved a/c ....... ': . '; ~.7--.~. .......z-. ........... './ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................ , . 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. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre{ or areas, and giving a detailed description of laybut of property must be drawn on the diagram which is part of this apF 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 pern shall be kept on the premises rwailable for inspection throughout the work. e. No buiht/ng shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town %f 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. (~applicant, o~ corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ..... /2. .... ...................................... Nmne of owner of prcnlises (as on the tax roll or latest deed) If applicant is a corporation, signatme of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ~2e~.../: ............. Plumber's Licens~No ......................... ,/ Electrician's License No.' ...................... Other Trade's License No ...................... Location of land on which proposed work will be done.. ~.. '.RQ/.~ .-'~,..~.. ~2..~/7/~ .~... ........ / .... .................. ...... .... ~ ~ Hamlet ~ County Tax Map No. 10O0 Section ................./0~ Block ....... ( .......... Lot. ................ ~' ~ Subdivision ' Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occupancy ~.~ b. Intended use and occupanc ................................... ;.. roperty lines. Give street and bloc ~terior or corner lot. Nature of work (cheek which applicable): New Building .......... Addition .......... Alterati}t.~ .......... Repair .............. Removal .............. Demolition ..... ~ ........ Other Work../.r7~.2 ~, .':~_... /__~.-~ ~ __.. .5~' l,~'~ (Description) Estimat a Cost :. :. ........ - · . , ..... / .;~ .......... 4- ........... . [ C_.~ ' ~'//C~/~, (to be paid on filing this application) If dwelling, number of dwellin~ units . :. .... 7. ...... Number of dwelling units on each floor ................ If garage number of cars ' If business, commercial or mixed occupancy, specify fiature and extent of each type of use ...... Dimensions of existing structures, if any: Front ..... ~ ......... Rear .............. Depth Height ............... Nu~B ber of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .......... Depth ................... i... Height .................... Number of Stories ...... '... ............ Dm~euslons ofent,re new cons/rtictton: Front .~:>: ~..;~ ........ R~'ar ............... Depth ....... Height Number of Stories ' Size of lot: Front ' ' ' Rear Depth ' Da te df Purchase .......... i ................... Name of Form er Owner ...................... Zone or use district In whtctl p~elnlSes are situated ................................... .'.... Does proposed constructiml, v, i61ate any zoning law ordinance or regulation: ...//ff..L). .................. V, fll lot be reoraded .... i .................... Will excess fill be removed from premises: Yes No Name of Owner of premises · Address Phone No Name of Architect ......................... ... Address ................... Phone No ................ Name. of Contractor Address Phone No PLOT DIAGRAM Locate, clearly ~d distinctly all buildings, whether ex/sting or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether FATE OF NE}go'FO RK,, ~ ' OUNT'kk '... as's .... ~x~~.~}.. ~. ~. being . ~ni~indi~qdual sigldng contract) ~ ~ove named. rI poses and says that he is the applictmt is the g~ , (Contractor, agent, corporate officer, etc.) smd owner or owners, mid is drily authorized to perform or have performed the said work and to make and file this >plicat. ion; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be perforined in the maim'er set forth h~ the application filed therewith. worn to before me this I Public, i · , HO, 52-~125550, Coun~..,~