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Home My WebLink About11922-zN9 (THIS PERMIT Z ~ TOWN BUILDING DEPARYMEN?i TQWN H~LL ',~ SOUTHOLD, N,.Y. : BUILDING P, ERMIT ~ BE KEPT oN ~H,E P~EMISE5 THE WORK AuTRORIzED) Date UNTIL ~ULL at premise~ located at County Ta~ Mop No. 1000 Section pursuant t? application dated Building I~spector, Rev. 6/30~80 ~roved by the Building InSpecto~ FIELD IN~.PECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY CODE o FINAL FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1602 Examiued..Y.:. ~.. ( ...... ,19 .Z..~ Approved...?.-.. ...... 19 .eermit Disapproved a/ .................................... .// / (Building Inspector) APPLICATION FOR BUILDING PERMII Application No./tx~...~.d ......... 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 Comity, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterati,9_u&,or for rem~gval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinanfes,.bwuu'~.~g)xS~d~, housing code, and regulations, and to admit authorized inspectors on premises and in building for neces~~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corp~r~te officer) · Builder's License No. ~..~?..x.] 2~./.~...~.~. ~ ~-7~... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade s License No. 5.~/..f-... 1., Location of land on which proposed work will be done ............. //. ........... .'~.. ........... ....... House Number ::~,~2 C_) Street Hamldt County Tax Map No. I000 Scqtion . ~.~...¢ ........ Block .... .~. ~ ....... Lot .~; ............ Subdivision~.~. ~-~/,~/ ~c,/~ v~c~,~'..~.~FiledMa No ' '']'.../f..~..~ ...... ........... (~q'a~) .......... F .... ' p ............... Lot 2. State existing use and occupancy of prem~ise_~s and in~ed use and occuy~ancy of PrOPosed construction: a. Existing ase and occupancy....~..~.~:~.~.7.,...~4.~k'.~. ~..~./.~/..,%f.C~. ............................ b. Intended use and occupancy .-~0,-f777.~. ,~. ........ ~-J~f~'~ r ........ 3. Nature of work (check which applicable): New Building .......... Addition..........~ Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. b, stunated Cost .. .~-~. . .'"~. · ........... Fee : (to be paid on ~ing this application) 5. If dwelling, number of dwelling units ............... 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 ............... tleight ............... Number of Stories ........................................................ I)imensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... 2'.. Height ........ ~ ............. Number of Stories ..................... 8. Dimensions,ofentirenewconstruction'.Front...l~........... Rear. .... ... ..... .. Depth ..1~)7.() ....... Height ..~...~.? ....... Number of Stories ........................................................ 9. Size of lot: Front ......... ' Rear ...................... Depth ......... ..~.....~..~..,.'1 10. I)ateofeurchase .......... : .................. ICameofFormerQwner .... C~?d.~.~-d'/..(...~.~.. /./.~. ....... 1 1. Zone or use district in which premises are situated ..... '.1.~..[.~/¢.~r~ t~(-~. ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................ ~ 13. Will lot be regraded ........ ;. .................. Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all/ buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK S S COVNZY .Z/¢.,,, ' · (Name of individual signing contract) above named. He is the ...................... ................................................................... (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 am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ,, .............. A ......... dayof .... .~..~.~ .... '~"' ', 19 '~'~ × Z~:/ , ~OTARY POSUC, State of ~ow Yon,. ' ~ .... fi'~'/'~ ' ..... ,~,: .' .... .~ ' ' '.;' ' 5~ I No. 52.4524771 '"' /,/ p' t~lgnarure o~ app.LmanO ~uallfied in Suffolk County Commission Expires March 30, 198, w~