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Home My WebLink About11575-z FO]~M NO. 2 TOWN OF $OUTHOI.D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPI~ETIONJ3F THE WORK AUTHORIZED) Dote ........................................................ Permission is hereby gr~nted to: ..... ~....~ ..................................... ~.~ ..................... Building Inspector, Fee ~...Z..~ .......... Rev. 6/30/80 _~-~-F~3 INSPECTION · FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY GODE FINAL COMMENTS ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OP SOUTHOLD ToWN HALL, SOUTHOLD, N. Y. 11971 765-1802 ~/~ 7~ ;1 FOI~I NO. I "tOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Applicatior Oisa praved arc ......................... ........................................................ .......................................................................... .............. APPLICATIOJ~ FOR ".[JILDII~4G PER/~41T INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin 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 streets ¢ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicntior c. The work covered by this aF~plication may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm shall be kept on the premises available far 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 Occuponc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections./,~ '\O- ~-(-~-' ~ ~.O'~ (SignatureL · of applicar~ .... or name, 'if a corporat'or ) '"(Address of applicant) State whether oppiic~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, .plumber or builde: ........................................... ;~~'::t:,.< ..................................... z~ ...................................................... ' ....................... Name of owner of premise .. . ~ ...................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... Plumbers L~cense No .............................................. .~. __ ~qectrician's License No ................... Other Trade's License No ............................................... 1. Location of land on which propos,e.~d work will be done Map_ No ..................... Lot No .. . Street and Number Municipality 2. State existing use and occupancy of p.~rem~ses and intended us~ and occupancy of proposed construction: a E×stnguseandaccuponcy ........................................................... b. Intended use and occupancy ............................................................................................................................... 3. Nature of work (check whilch applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. RemoVal .................. Demolition...,~: .............. Other Work .................................................... ' j ~1~'~' (Description) 4. Estimated Cast .......... ~ ........................................ Fee ...1..~ ........................................................................ I (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number of cars 'i ........................................................................................................................................... 6. If business, commercial dr mixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structbre with alterations or additions: Front ....................................Rear ........................... Depth ............................... i Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....................... Hieight .................... Number of Stories ............................................................. ....................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ............................... 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11, Zone or use district in which premises are situated .................................................................................................... ]2. Does proposed constructioq violate any zoning law, ordin6nce or regulation: 13. Will lot be regraded ..........~ ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises i ................................................... Address ................................ Phone No ...................... Name of Architect .......... i ................................................... Address ................................ Phone No ...................... Nome of Contractor ~ · ....... ~ ................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dmstmctly~ all buildings whether ex~stmg or proposed and re&cate oil set-back d mens~ons frorr proper~y lines. Give street and !block number or description according to deed, and show street names Qnd indicate whether interior or corner lot, COUNTY ....... ~~~ .............. being duly sworn, deposes and says that he is the applicon (Name of individual ~igning contract) above named. He is the .................................... ....~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ~du[y authorized to perform or have performed the said work and to make and iii- this application; that all statements contained in this application are true to the best of his knowledge and belief; thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ ..... of / ' .