The URL can be used to link to this page

Home My WebLink About11719-z~ B~ILDING · BEKEP~0N ' (THIS COMPLE'rlON OF THE Pel'~issi0n!is hereby granted th: at p~emise~ located ~ Ta~ Map No. 1000 ~Section t~ application dat~l Ir~spector. ~roved by the FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOED BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .k/~//9,.¢:...~. .... , 19 .o?. Approved~.O../?.~.....~. .... , 197.t/. Permit No. Disapproved a/c ....... i_'" ~'~' ......... "~ ..... ',' '/ APPLICATION FOR BUILDING PERMIT Application No.././..~.f. 7 ....... 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 befor~ 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 wqrk. e. No building shall be occupied or used in whole or in part for any ptirpose 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, bhil4ing code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. :. . . r .V,, . . F. . . . . : ............ (Signature of applicant, or name, if a corporation) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gen{ral contractor, electrician, plumber or builder. Name of owner of premises ...~.Rq-tq. ~ ,L I,~J .... ,O. ~.%T, .~J.~. ........ :,.,,J. ~.(Z,-~> ..,. (?. Y l t:.~.:. {,.': ( .:} .... (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 .... . .~7 .J.~. ................ PIumber'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 ... ~ ~ .......... Block ... 2~.~.~ .......... Lot. ~ .~. ~ .'.~'25} .... Subdivision. .~.. : ':. ~ .1:,~.~,~ ..... ,,: .. ~-<~,,~.. Filed Map ~o... ~. ~ .... Lot ...:-: .( ........ (Name) State existing use and occupancy of premises and intended use and dccgPancy of proposed construction: a. Existing use and occupancy ....... ~ ~%.~.. m~ ...... ~m~10. '~ ................. b. Intended us, and occup~cy ...... ~.~... 3. Nature of work (check which applicable): New Building 2 ......... Addition .......... Alteratiof~ .......... Repair~ .............. Removal .............. Demolition .............. Other Work. i ' (Descriptiofl) 4. EstimatedCost.. .~.~ ~ Fee .......... ~. d (to be paid on filing this application) ili ' g ~ $. If dwe ng, number of dwelhn , nits ............... Number of dwelling units on each floor ................ I[ garage number of cars ' 6. If busifiess, commercial or mixed, occupancy, specify nature and extent of each type of use ..................... · · · ' · pth 7. Dm~enslons of existing structures, if any Front ............... Rear .............. De ............... Height Number of Stories Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Number of Stories ' Depth ~ Height ...................... 8. Dimensio,ns of entire new construction: Front ............... Rear ............... Depth ............... Heighf . ~. ............ Number of Stories ............................................ , ............ 9. Size of; 10~} Front .... //~ ~ ~"~ /~ ~ ' n~,,*h ' N of F rmer O 10. Date o.fPurChase. ........... :'. ................. amc o wrier ............................. e dist i t in which pr~mis ituated 11. Zone or us r c es are s ..................................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ....... ~ ........... Will excess fill be removed from premises: Yes No 14. Name of Owner of premisest:r,¢a,~...~.~.4~, t~ ..... Address i.to.o..~,,,~n,~.b.~..EIoR~. Phone No. ~9.~.-..~.q'O./,~ .... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No .............. PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~].~. YO, P,~, COUNTY OF..~...O-..~.~a[.~ ...... i a'o ......... ~ ...~.~ ~.~... ~ ..................... being duly sworn, deposes'~d says that he is the applicant ~ (Name of individual sig~ing contract) above named.'*' He is the ....... . ...................................................................... ~ (Contractdr,~ . . agent, corporate officer, etc.) of said owner or owne~, ~d is d~ly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements con~ed h this application are true to the best of his knowledge and belief; ~d that the work will be perfo~ed in the m~er set forth in the application filed therewith. Sworn to before me this ~ ............. ~ ...... ,day ~f ........ ,.-~. ~ ..... ~mm sslo0 Expires ~arch 30, 19~