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Home My WebLink About11664-z FO~'~ HO. ,A TOWN OF SOUTHOL ) }! BUILDING DEPARTME ~T TOW~ ,~[L SOUTH'OLD, H~ I. ~ BUILDING p, ERAAIT!' , (TH:S PE~tT MUST BE KEPT ON'THE P~EM~S~S UNTIL COMPLETION OF THE WORK AUTHORIZED) F~LL · ~.~.~..,.~Z.~..~.,~....,i.~....~.... ............ ......... ~..~. .~.~.~.~ , .~.~, ~o ....... ~...~.~......~.~...~ ....... ~z~ ~.~,~z~,./~....~ce .... .....~ . ~ ....... ~~...,~....~ ~..., ,..: ..... ,.: ~ . . ..................... : ~. ~ ~ ~ ~ ~/~/'"~ ~ ...... ~, .... ~ ~,~ ,o~ ~ ..~ ....... ~.~ ~~...~ ~......~ ........................ ....... ~ ......... :.;. .................................................................. :.......:..:.........z~ ~..~~.~.~ Co~h~ To~ ~op ~o 1000 Secton ......... : .... Block .......... ' ,or No. ~ .......... pu~s~ant tb application dated ' ~ ~ ' .................... ...~....,. .... Building I~spector. FIELD INSPECTIO~ 1. FOUNDATION ( 1 st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C, pDE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ .~!'.?~..., 19 ~..~ Disapproveda/c .......... ~..'..-~. ........ .....O....... / ¢// APPLICATION FOR BUILDING PERMIT Application No. [./~. ~.~--~ ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application 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. /,,.~ ~.,.'~: to .... '"--~"~'~ .... .F',re,,... F...~.~. ~.. .......... ~ (Signature of applicant, or name, if a corporation) ~/:" ~-~- .?..o.,.~...',t ~..~ 0~.'T..,T..<,m~....~.. f.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ......... .c..o.~...~..~%.c ........................................................................ Name of owner of premises [~g~-. ~f'.~...~.o~...-.. ~.(.a?~inQ~'~2~o. li ~)!~i~;;;t.~;e.~).~.[ ..................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 1~'""/6'~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .. .......... ............................. House Number Street Hamlet County Tax Map No. 1000 Section .. [ I. VJ ........... Block .... k.[,,. ........... Lot...-~). 'i~"i ........... Subdivision ......... ~. .......................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~..~..~,.-..~?..v~..;.].x/...- - ~.~..e.::~]! .~'.q ............... v.. ~. ......... b. Intended use and occupancy ..... .~, .~,~....., ~ .~q. i. !7'-- IC[ .~..e..!! t ..~1il .... i:.~ i . .'.: ................. of work (check which applicable)!: New Building .......... Addition .......... Alteratin,~n . .n .......... 3. Nature Repair .............. Removal "',~i .......... Demolition .............. Other Work. +~e.,~ .~(Descripti~n) .... 4. Estimated Cost q~ /.7~.~: ~ .. i ...... Fee . i } (to be paid on filing this application) 5. If dwelling, number of dwelling iunits .. 1 ............ Number of dwelling units on each floor ......... ' ......... If garage, number of cars .... ~ ...... q .......................................... : ................. 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use .......... i i i ........ 7. r)imensions of existing structures if any:i Front ............... Rear .............. Depth ............ Height ............... Number of Stories ........................................................ Dimensions of same structure with alteralions or additions: Front ................. Rear .................. l[)epth ................. '.. 2.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: t~ront'~ ............... Rear ............... Depth ............... Height ............... Number-- ~,of S ories .......................................... ,~ ............. 9. Size of lot: Front .... ~O.O.( i. .... .I .... Rear ...... ?~.~.( .......... Depth ..../.o.,~ ............... 10. Date of Purchase .......... ~ ................. ~ Name of Former Owner ............................. 11. Zone or use d~stnct ~n which premises ar s~tuated ..................................................... 12. Does proposed construction violate any ~oning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~J ......~ ............ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~//']./,~}/~J .......... Address~'~.~.O ~.~,~..~.q/~d./{...~.. Phone No. 'T&'[/.--. &~.OO .... Name of Architect ......... i ...... t Address ........ Phone No Name of Contractor ........ ~ ...... ~ .......... Address ................... Phone No ................ Locate clearly and distinctly alli buildinl property lines. Give street and block number interior or corner lot. STATE OF NEW~ORI~ .... COUNTY OF Iq' ..... .......... i .... PLOT DIAGRAM ;s, whether existing or proposed, and, indicate all set-back dimensions from )r description according to deed, and show street names and indicate whether · · i ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............ i ............................................................. {Contractor, agent, corporate officer, etc.) owner or owners, and is duiy author, ed to perform or have performed the said work and to make and file this of said application; that all statements conthined in ~his application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forih in the application filed therewith. Sworn to before me this _ .............. ~....~. .... day o ~mm~sston Expires March 30,