The URL can be used to link to this page

Home My WebLink About12038-zBUILDING DEPARTMENT TOWN ~HALL SOUTHOLD, N. Y. BUILDING- PERMI1 · (THIS PEPJ~IT MUST BE KEPT ON THE PREMISiS UNTIL ~ULL COMPLETION OF THE VORK AUTHORIZED) Permi~ion Is hereby granted to: Coun~ Tax Map No. 1000 Sect on ................... ~...~ Bilk .~....~..~ ............ , ~ot No. > ....... ~ ............... pumuant to ~lico o da ............. ,; ........ / .~..._ .. :., and appmv~ by the Building Iflspector. tort FIELD ~NSPF£TION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY G~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined ~.. · . .Z. ~. ..... , 197..2~ Application No../.~.~..~..~. ........ Approved ..... , No.. ;. Disapproved a/c ...~_;._~..;.~;.~ ...... ~~~'~f~ ........... ................................ '; (Building Inspector) .... APPLICATION FOR BUILDING PER~IT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 constraction 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 buildh~g for necessary inspections· ·../5~. ~.:~.../¢'~K..., .~.o(~.. :.- ............... (Signature of applicant, or name, if a corporation) . r. . . 4.'7. .,q,. & :./q ,. !.u. .t(. ./ /. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, eng4neer, general contractor, electrician, plumber or builder. · ('.~. ~.x.w. 03 CF.O.~. .................................................................................. Name of owner of premises . .~%. I.~.q...~. t .c'~ c. I / ] I. ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ....... 5X¢?~ .~.,?.'...-?. ~...P~ ~.~(~?..e. ........... (Name and title of corporate officer) Builder's License No. /°~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. /¢(-0....,2.(,ff. ..... ¢: ?: .... /. House Number Street / Hamlet County Tax Map No. 1000 Section .... .U.~. ........... Block . 't Lot. Subdivision ..................................... File'd Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: 7' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val ............ Demolition .............. Other Work. ~.~'YlC t'~ fl .... · Z (Description) 4. l/istimated Cost ...... ~.°~. 0 ° ~' Fee (to be paid on ~ing this application) 5.If dwelling, number of dwelling hnits ............... 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 ..... if any: Front Rear Depth . Dlmensmnsofexlstmgstructurds ............................................. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. r)epth .................... :.. Height ................. .. ...NumberofStories .................. .... 8. D~mensaons of entire new construchon: Front ............. ,.. Re&r ..... ~. ......... Depth ............... Height ............... htnn~b~, ,f S ion~-... ~....c¢ ~.tL~ VI.. [4 ~.~...ldeA4o-e~ ........... ; ............. 9. Size oflot: Front ....... .9.0. '..: ...........Rear.. '].q! ............ Depth .... ]..00.: ............. 10. [)ate of Purchase ........... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ ' .,13.~ Will lot be regraded ....... ~ ................... Will excess fill be removed from premises: Yes No .<, 1~4'; -34a~e of Owner of premises .-grig././.~...~./¢6'r-./. ~.//. '.. Address/-,;/¢,,$eA(. ,f~',sl>.. ~.~ofl. q'~rt~one No.. ~?. ? :~.~... '"' Name of Architect ............................ Address ................... Phone No ................ Name of Contractor ......... ' ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from properW lines. Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot. / .~~' 7" STATE OF NEW..,Y,.QRK ,~ ~ COUNTY OF ~.~,~/2{~ I'/(' ~ ;~ .... ~ .... ~: ~ ........ ~ ~}i¢?t. CF(~ .............. being duly sworn, deposes and says thane is the applicant (Name of individual si~ing contract) above named. ,~ ~e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application;'that all statements cont~ned ~ this application are true to the best of~ ~owledge and belief; and that the work will be perfo~ed in the m~ne~ set forth Sworn to before me this . y ................ , ....................... of .. .................... - ~ ~[tZ~H ~ U~tt~ (S~gnature of apphc~t) ~0~aY ~6~[1~, $t~(e of How ~o. 52.8125850, SOl,elk c0u~/ hrm Ex0ire~ Marc~ 30, t9~ :