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Home My WebLink About11615-zN°. 1~;1615 TOWN OF:s~UT"OL,_~ ~ BUILDING DE}'ARTMEI~ITr' TOWN H~LL SOUTH'OLD, BUILDING ~E~I (THIS PERMIT MUST BE KEPT ON THE PREMISF~S UNTIL F ILL COMPLETION OF THE WORK AUTHORIZED)~ · ~ Date Perr~ission! is hereby granted to: FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY 2.0DE FINAL ADDITIONAL COMMENTS: / FORM NO. 3 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ......... ~ ............... · To ..... ro~ ~ ~o ~o~ ~sz~ . .C~c~. ~ .................... a~ House ~o~ ' ~ ~ Street [ / Hamlet co~ty ~ ~ ye. ~000 s~t~o~ .. oSd. ..... ~oc~ ...... 0.~ .... ~ot ..o.~ ..... Subdivision.. Fi~6 M~p ~o ....... ~ Lot ~o .................. uu[lding Inspec ' RV 1/80 ~4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... Approved X~.~..E'../...../.....'~... ............. 19~,.-~...-- __Permit No, ..~.~.~X~~ Dmsapproved a/c ...,~<...~ ................. ~ ........................... ................................................... {Buildin~ Inspector) Application No../../'..~../,...~.Z ............... APPLICATION FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oX in ink and submitted in triplicate 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 public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js part of this application. c. The work covered by this applicatipn 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 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 MADE 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~' (Signatur applicant, or name, if a corporation) ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... . ..... Name of owner of premises ........ . .~..Q..~..~. ....... ~...: ....... .,..~.....~.~...~.../~.~.Q .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~.~=~...- .~..... ....................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Subdivi8 io~,~ --~ ~'~'~'~ Street and Number ...... ~.~..~, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended County Tax Map No. Dist. 1000 Section 3~,~ Block ~ Lot yO;/ I 3. Nature of work (check which appticible): New Building, ..-~...~... Addition .................. Alteration ................. Repair .................. Remavdl .................Demolition .................... Other Work ..................................................... 4. i ' (Description) 4. Estimated Cost...1~...~. .................,... .......................... Fee ..... ..~.../~)....em~..,...~..~.: ...................................................... i (to be pai/I on filing this application) 5. If dwelling, number of dwelling uni' . ........................... Number of dwelling units on each floor ............................ If garage, number of cars ... ............. 6. If business, commercial orI mixed ~ccupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing struc!ures, if a~y: Front ............................ Rear ................................ Depth .................... Height ........................ Number of ~Jtories ................................................................................................................. Dimensions of same structu?e with Jlterations or additions: Front .................................... r Rear ............................ Depth ................................ iHeight .[ .......................... Number of Stories ................................ 8. Dimensions of entire new canstructi n: Front ...... I..0. ......................... Rear .....l.0 ................... Depth ..../....~.. .............. Height ....~..~ ............ Number of Stolies ........... ~ .......................................................................................................... 9. Size of lot: Front ................ ............. r ......................... Rear ......................... Depth ...................... 10, Da!e of Purchase ...... ./..~.~..~. ......... "i' .......................... Name of Former Owner .~.~])n~.~....1~..~.£.~...,.~£~..~...,:~,.... 1 I. Zone or use district in which premise]s are situated .......... .~...~....~.. ................................................................................ , 12. Does proposed construction violate a y zoning law, ordinance or regulation: ...... ,/..~....o. ........................................ 13, Will lot be regraded ........... ..~..?. ........ ~ Will excess fill be removed fr~m premises: ( ) Yes ( No i4. Name of Owner of premises ...!...~...°..~..m.J....~.:......~-~.~..ff..C~'.~ Address .~;~l.*.f,~?,.. ~.,~.;. Phone No. Nome of Architect ...........~.~..J..~...., Address Phone No. Name of Contractor ......... ..~...~_...,/'..~.. ...................................... Address .......... :: .................... Phone No ......... --~[ ............ PLOT DIAGRAM Locate clearly and distinctly bll build~ ~gs, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and b?ck nut,bar or description according to deed, and shaw street names and indicate whether interior or corner lot. ' /o .~'~'ATE OF N~/t/YORIX.. IS S COUNTY OF .....~..~...'~?.~.,..,).~ .......... [f ' (Name of individual signing co above named. Fie is the ................ (Col of said owner or owners, and is d~ly auth~ this application; that all statemenlts contel that the work will be performed in }he manl Sworn to before me this ...... ,mm ............ day of Noto Pub i ....... :'""i ............. ~IOT/~RY pUBLIC, State of NewlYork o 52-4649732, Suffolk County ........................... being duly sworn, deposes and says that he is the appiicam itracf) ~tractor, agent, corporate officer, etc.) dzed to perform or have performed the said work and to make and file ned in this application are true to the best of his knowledge and belief; and ~er set forth in the application flied therewith. Co,n ........... .............. -(Signature of applicant) 24 >c_A L.&.. 40'= i21 =~ 7,%C~t'~/A,~t-4T i