The URL can be used to link to this page

Home My WebLink About11646-z 'BUILDING P.,ERMIT (THIS PERMIT MUST BE KEPT ON THE 'PRE~ISE~S COMPLETION OF THE WORK AUTHORIZED) }~ 11646 UNTIL FbLL Z Building Ir~spector. Fee ~; ....... ~ .... to ........... ; ................................................. ?-.. ~..; ............. i~ ............ .~ .......................... at premises located at ..... .,.4~..: ~ ~'~.~.,.~.,;~.., .................................... · .............. - ~. !i (..¢.~.~;.~. ~,~../..: ....... ~ ............................................................... ............. ~,,.. ,~.~./.~.~,7.~,~/...__. .. y ..... ..... ,..? ........ .~ ................................................... ? ........................... ;..,,~ ................ ~. · .......................... ./.~.~, · ,,~.~. ,~ ~ ~. Cot~ty TaX Mop No. 1000 Sechon ........ ;..., Block, 'i .,,.?.. ot No. pursuant t6 app cat on dated ...... ~. ..... : ....1'9 end ~pproved by the FIELD INSP~IO~ FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING {2nd) INSULATION PER N. Y. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO, 1 TOWN 07 SQUT'.qOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.~ 765-1802 Disapproved a/c ....... : .................... ~ .... '. / (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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, relationsh,.'p to adjoining premises or public stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of'this ap 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 per: shall be kept on the premises available, for inspection throughont the work. e. No buiidJag shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa~ s!:all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building Permit pursuant to Building Zone Ordinance of thc Town 'of Southold, Suffolk County, New York, and other applicable Laws, Ordinance.~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a_nd admit authorized inspectors on premises and in buildings for necessary inspections. · ........ (5'ignature of applicant, or n~me, if a corporation) ./3o'..& .~. ~.,.. :..C,~.E .~.&..-~,,-~ d. ~.~. (MaitL~o address of a[bpticant) - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or built ('as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) Bnilder's License No ........ .~.~.~.-r(.. .......... Plumber's Licenst Electrician's License No.' ...................... Other Trade's LicenSe No ...................... 1. Location of land on which proposed work will be done..~.~..~..., .~. &..Q 9.r7.. ~ .I.t.. ~ 0.~ ............. .... ~q .......... ~n~n. ~ ~I.~ ................ ~~ .............. House Number Street Hamlet° County Tax Map No. I000 Section ..... JO.~ ........ Block .... 9.3 .......... not. P.g 3, .9.~/... Subdivision .................................. Filed Map No ............... Lot ............. (Name) 2. State existing use and occupancy of premises and intended us~ and occupancy of proposed construction: b Iatended usc ~O occupancy ............ ~,~ ~,~ 3. Nature of work (chcck which applicable): New Building .......... Addition .......... Alteration ........ Repair .............. R~mo.al .............. D,.moht,(3n ......... Other Workff~ ~ ~.~ .... 4 Estimated Cost ............................ .. . Fee . . ............ .. . q ........ . (to be paid on filing this application) 5. I~ dwelling, number of dwe mg units ............... Number of dwelling units on each floor .............. If garage, number of ears .. ~ .................................................................... 6. If business, commercial or mixed occupancy, specify hature and extent of each type of use .. Di nsio s of xi ti c{ if y: F R Depth 7. me n e s ngstm ures, an ront ............... ear ........................... Height Nt ~ ~ber of Storms Dimensions of same stmcturq with alterations or additions: Front - Rear Depth ...................... Height ...................... Number of Stories .................... 3. Dimensions of entire new coflstruct~on: Front ...2.e.q. / .. Rear . d.o .......... Depth .~.~ ~. ~ ..... Height ... ~: {. $90;4{Fs.. Number of Stories .................................... Date 6fPurchase . .]. ~ ~4 ....... ~ ........ ~... N~me of Fom~er Owner . .~/.~ J ...... Zone or use district .... ' ': n whlch lprelnlses are situated Does proposed construction violate any zoning law, ordinance or regulation: . .~ .......................... Will lot be regraded ...t~ .Q~. ',"',- ~. ~ ..... ~.. ~...,. Will excess fill ~ r~v~d from premises: Yes Name of Owner of premises ~&l~?~. { 2,~ ~c¢~Address~¢ ~. >V ~~hone No~.{ l ~6 o~ Name of Architect .... ~ ~ ............. '.. Address .......... {.. Phone ~ ....... 10. ii. 12. ~3. 14. PLOT DIAGRAM '"' Locate clearly ~d distinctly ~all ot ildings, whether existing or proposed, and. indicate all set-back dhnensions fro: :,roperty lines. Give street and block number or description according to deed, and show street names and indicate wheth, ,~terior or corner lot. ~TATE OF NE~ORK., ~ COUNTY OF .~{.4~t~..'.., .... · ~ (Nanie ofindMdualsil above named. S.S ning contract) being duly sworn, deposes and says thane is the applican (Contractor, agent ) corporate officer, etc. ) o.. s~d .owner or own'ers, a/)phcaImn; tJmt all statements codraiaed W'ork will be performed in the man,er set forth h~ the application filed therewith. ~worn to before me this P~blic ............... ~~/.. County