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Home My WebLink About12086-zTOWN OF $OUTHO~D BUILDING DEPARTMJNY TOWN HALL $OUTHOLD, N. ¥. BUILDING FERMI~ ; (THIS PERMIT MUST Bi:: KEPT ON THE PRE~t'~ISES cOMPLETION OF THE WORK AuTH(~RiZED) UNTIL ~ULL N? 12086 Z Permission is hereby granted Date .......... ~ ................. tO ............ ; .......................................... .~, .......... ...... , ...................................... )...~,~. .................. .~.¢ ........ :,~ :~..t.... ?.~,....~....~ .... at pmm~ses I~at~:l at .......................................... t ............... '~'"'~-';-'.'~' -' C°Uhty Tflx Map No. 1000 Section, .......... :; .......... .~ Block i,...};....; ........ pumuant ¢o application dat~:l .............. ; ............. ;....i7..., ~Y .... Building Iflspector. ; }' Fee $ ........ , ............... ,./c~ ~ ~7~ Lot .......... ~'and '~pproved by the Building Inspecto~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined/~.~...~..~. .... , 19~.:2'~ Approve/~..7~'.0....Z-../? ..... , 19~..'g~. Permit No../...~?.?: .~.! Disapproved a/c .............. C ......... .(i- ........ / APPLICATION FOR BUILDING PERMIT Application No ~J0~ 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 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 building for necessary inspections· .. 77.~.,.,?. /¢..~. lrrG'.v.~. .cr. .~ : .................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) / t ?S ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ....... ........................................................................... Name of owner of premises . ~..c{t.~rl..c.c~..V.O-.o. .~0. ?C..~,. ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· .... 4c. ................... (Name and title of corporate officer) Builder's License NO ........ ].~ ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ?.z. ..P.o.,: House Number Street Hamlet County Tax Map No. 1000 Section ..././..~.' ........... Block .... .~. ............ Lot .... .]?-). ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy., .Q./~..~-.....~.k~../..~H.. ~..ti~.~.//,I.,G~· .................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration ~: ........... Repair .............. RemOval .............. Demolition i ........... - - Other Work/7~.~.~?.~. '2 ..... .<~./~/ i (Description) . ........................ 4. Estimated Cost ........... ~ ......................... Fee ...... (to be paid on filing this application) 5. If dwelling, number of dwelling Chits ............... Number of dwelling units on each floor ................ If garage, number of c~s ..... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing stmcture2s, if any: Front ............... Rear .............. Depth ............... [[eight ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth ' HeiSt Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... HeiSt ............... Number of Sto~es ........... . ............................................. 9. Size of lot: Front .... /&~ ~. i Rear .. [.& ~.~ .............. Depth .. ~ ~ / .............. 10. Date of Purchase ........... ~ .................. Name of Fomer 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 lo~ be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No Name of Architect .......... ; ................. Address ................... Phone No ................ Nme of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAG~M Locate cle~ly ~d distinctly ~li buildings, whether existing or proposed, ~d, indicate all set-back d~ensions from prope~y lines. Give street and block humber or description accordMg to deed, ~d show street names and indicate whe~er inte~or or corner lot. STATE OF NEW ~O~,. ~; / ' !S.S COUNTY OF . .~.~ro.l.l~. ...... ~.~ ~..~., ~e,/£-/F_~e 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.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannelr set forth ~in the application filed therewith. Sworn to before me this ..... ~ ....... day ...... ~~ 19~. . ,~.~~ Public, .............. Cou . ~c~ , ~rt~n ~}~s ~rvltt~ (Signature of applicant) NOI~Ry PUSLIO, State of New Yorlt i term Expires March 30, 19~ ] No, 52-81258fl0, Suffolk Co~ltl FIELD INSPECT~ON FOUNDATION (1st) FOUNDATION (2nd) ]tOUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE COMMENTS FINAL ADDITIONAL COMMENTS: