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Home My WebLink About11668-z TOWN OF soUTHOU~ · BUILDING DEPARTMENT TOWN H,~LL SOUTH'OLD, N;, Y. BUILDING :PER,~tlT ; (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL F~LL COMPLET ON OF THF. WORK AUTHORIZED) ~ N°- 1;1668 Z Permission is hereby granted to: ~ ~ ;~ ~,/ , j ..... ....... t. ...................... ~ ...... ....... ~ ........................................................ ~.T'"-'~ ", ........ 7"'"~ ~ ............... ~:' ....................................... ~ ~, ~o~ ~ ..... .~.Zq ........ ¢~.~Z..m ~*.,.~ ............. ~ ......................... ' ~V'; .............................................................. .......... ~ ..........." : '" .......... ~/~.~.;.... .............. ~..zzff .......... Co~ ,o~ ~op ~o. ~ooo s~,o~ ....Z~ ......... ~o~k...~ ......... t uo. ;.~Z.~ Building I~spector. ~o~ $.~.. ................... · Rev. ~6/30/80 ~uilding Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 E,,amined/Q' ~' '7'' "'" Z.., l~'~..~ ^pproved ' ' '~' ~'7" '" ~'" i' .?~e,-mit No. ,<'"~.e. ~ ................................ APPLICATION FOR BUI LDING PERM IT INSTRUCTIONS Application No.././.~..~..~' .' ....... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets o[ plans, accurate plot plan to scale. Fee.according to schedule. b. Plot plan showing location of lot and of bui/dings 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 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 tc admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .W...~'~.....Q....~....~'x..~..?.: .%.~..';~ ..................... ~//--~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~ .............. Plumber's LicenseNo ......................... Electrician's License No ...... ~ ................. Other Trade's License No ..... : ................ 1. Location of'land on which proposed work will be done...~.~,~..z?'.'~~ ............................. ....~.Xe....~C.~..~. ~.."...-2:~. ~..o~.. ~ .......................... House Number Street Hamlet County Tax Map No. 1000 Section ..../.O.~. .......... Block ..... O..~ .......... Lot...O./.,~ ............ Subdivision. OO~O-.'5...]~.t~.~..C[...~"..~.~....O,~%. ' FiledMapNo..(.(°.2q~ .... '.. Lot..ff..~. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~~ .................................................. -b Intendcduseanaoccupancy ...~.,~.~;..%%-....~.~..':.:;~..~'..~. Repair .............. Removal ............. Demolition .......... ----- Other Work..'~-g~ ~. i".. I (Description) 4 Estimated Cost Fee i (to be paid on filing this application) 5 If dwelling number of dwelling units i Number of dwelling units on each floor If garage number of cars ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ............... Number of ~tories ....................................................... Dimensions of same structure ~'ith alterations or additions: Front ................. Rear ................. Depth ..................... Height ...................... Number of Stories 8. Dimensions of entire new con,, truction:!Front'~ ,..; Rear ............... Depth , ....... ,.,. ............. Height ............ ~ s ...C]-~t.ta ....................................... 9 Size of lot: Front ~ Rear Depth 10. Date ~fPurchase ............... 1 ............ Name of Former Owner ........................... 1 1 Zone~or use district in which premises a~re situated 12. Does proposed construction viblate anyizoning law, ordinance or regulation: ............................ ,'" 13. Will let be regraded ; ....... i'-, ..... i' ' ' ~ ...... Will excess ~I1 be removed from premises: Yes No 14. Name of Owner of premises~ ?'~Z.. ~ Address~.?~___~~~.,,L.. Phone No.~-~,~'. 7'z~/.~. .F. ~.... Name of Architect ......... , .......! ........... Address ................... Phone No ................ Name of Contractor ..... :, Address Phone No PLOT DIAGRAM Locate clearl.y and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block numbe~ or description according to deed, and show street names and indicate whether interior or corner lot. : STATE OF NEW ~K~/ ~ ~' i S S COUNTY OF · ..... ?. (Name of individual sig~ing eot above named. tact) being duly sworn, deposes and says th~fi.l~e is the applicant (Contractor agent corporate officer etc ) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this application; that all statements contained in ithis application are true to the best of his knowledge and belief; and that the work will be performed in the manngr set for[h in the application filed therewith. Sworn to before me this ' ~ .............. ~.. .... day of ...... ..~. ....... 19 .~..C;q- Notar,,v Public, ....... ~ ...... _.,.~,~,..~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C DE FINAL COMMENTS ADDITIONAL COMMENTS: