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Home My WebLink About11707-zPerr~ission~ is hereby g BUILDING DE?ARTME~NT~: SOUTH'OLD, BUILDING P,E~IT~ (TH S PERM T MUST BE KE~T ON T:H, COMPLETION OF THE WORK AUTHORIZED) Z Dale at p~emise~ located at ....... J ......... ,: ...................................................... ...................... ~"ii'"!~'"':'"'"~ .... C0urity Tak Map No. 1000 Section .,...'~,,,.,t,.~...?..,..., ~locl~ .~.,~.~ ........ pUrsUant t~o, application dated ..... ~.,~.~..,~ ...... ;...,~...'., 19;~.. ~cto? FIELD INSFECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY GODE COMMENTS FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT .. TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 ......... ,,9.:..X ...... Approved.. ./' ....... ,l .:.me=tNo. Disapproved a/c ......... --~..-.-... ................ : ........ .... _ APPLICATION FOR BUILDING PERMIT Date4.. .. 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 shaI1 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 andin buildings for necessary./~.~_xz__/.z/(...,,,/i.a~p, ections. __ ff'~ ,~ /. ~ (Signature of a~plicant, or name, if a corporation) ............ .................................. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, g,eneral contractor, electrician, plumber or builder. Nmne of owner of premises .......................................................................... (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 ....... . .t~....~..~...' .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....... ~.... ! .............................. House Number Street Hamlet 'County Tax Map No. 1000 Section ...... ~.: lO. ....... Block .... 0:.i~ ........... Lot...QO..'~.: ?..Q .~ .... Subdivision ........... ~ ......................... Filed Map No ............... Lot (Name) State existing use and occupancy of pr,~nises,and intended use and occupancy of proposed construction: a. l~Xlsnng use anu occupancy .... ~' ..................... : .......... . ................................ b. Intended use and occupancy ' ' ~., ??/ ~...4.~ ................. ,..~ .,, , .::. ~2~ .................................. Nature of work (check which applicablel New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val ............. Demolition .............. Other Work..P..~'~ .~..~. ..... ' ' (D ipti ) i escr on Estimated Cost /. ?..qc)..~' Fee /,.~.: .d~.O ~ (to be paid on filing this application) If dwelling ' ' ' Number of dwelling units on each floor , number of dwelhnglumts .............................. If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mixed occupa 7. Dimensions of existing structures, if any tteight ............... Number of S Dimensions of same structure With alter, Depth Heigl 8. Dimensions of entire new construction: i tteight ... ~ tr Number of S acy, specify nature and extent of each type of use ..................... Front ............... Rear .............. Depth ............... :eries ....................................................... tions or additions: Front ................. Rear ................. .t ...................... Number of Stories ...................... ~ront..a.q?.r. .~.oy.?.... Rear ............... Depth .g.~. ]c.e.~, ?~. .~. ~.X...q :eries ....................................................... 10. 11. 12. 13. 14. Size of lot: Front .......... ! ........... Rear ...................... Depth ..................... Date of Purchase Name of Former Owner Zone r use district in which pr misos ar. situated ..... Does proposed construction violate any ::oning law, ordinance or regulation: ./~..o. .......................... Will lot be regraded ...~.~.... i ................. Will excess fill be ~m{lved from_premises: . Yes Name of Owner of premises ~,, q$ /do .~L~' ' . Address .~.°F.~....~..~..~.~../~. ~rt~one No. ~).~...6.~..? Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor" Address Phone No Locate clearly and distinctly al! buildin property lines. Give street and blockinumber interior or corner lot. ~o 6e e~S~ 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 STATE OF NF.,W YOYOYOYOYOYOYOYOYOY~K.,/~ 'S ~ COUNTY OF~... '~-- above named. being duly sworn, deposes and says that he is the applicant He is the ......... of said owner or owners, and is duiy application; that all statements conthined in work will be performed in the mann{r set Sworn to before me this ............ ~)C.~TF. ~d'~y o~ ..... u ie' .... ~, agent, corporate officer, etc.) or have performed the said work and to make and file this application are true to the best of his knowledge and belief; and that the h in the application filed therewith.