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Home My WebLink About11791-z BUILOING SOUTH'O[D~ N~ ¥. BUiLDiNG;: PERM!Ti (THIS PERMIT MUST BE KEBT ON COMPLETION 0F ~HE wORK $ ONTIL F~ULL ~erfi~ission is hereby gronted ~o ..... · ,, ~ C0uhty TOX Map No. 1000 ;Section L ....... ,.~. Bloke pursuant to apphcohon dated ..... ~Z~.,:.....~....--.~,..? ~ev 6/30280 '- ~ 5 and ~pproved by the FIELD I~PECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined ....... , 19 . . . -~-~ Application No..,4'../~. ~'./. ......... Approved .~.~../.~... ~ .... ,19 .~..~ermit No. ~../~. ~../.~ . / Disapproved a/c .............. -. ,.. i.~...z:~. ..... ~.~ ......... / INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~ to the Building Inspector, with 3 sets o~ 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 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, housing code, and regulations, and to admit authorized inspectors on premises and in bnildings for .nec.?~ msp~cuo~g.s< / .~.~' ~ (Malting address or app ica t) Date ................. I9 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~ .......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ..... .~.~fi~-- ............. Plumber's License No ......................... Electrician s License No ....................... County Tax Map No. t000 Section ....~.~.. ........ Block .... r ........... Lot..A~'. ~ ....... Subdivision .................. . .-r-:~..". .............. Filed Map No ........ · ....... Lot (Name) 2. State existing use and occupancy of premises and i~nded use and occupancy of proposed construction: Existing use and occupancy ..... -~J~/. .... ~.~.~..~-2~..~.7 ............................... a. b Intended use and occupancy ....~'~'~.~..--..~./... ~ .............................. 3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration ...[. Repair .............. Remgval .............. Demolition .............. Other Work...~.,~(~.~-~.~.. 4. Estimated Cost ........... '. e (to be paid on filing this application) fd gl ~'- fd lling it hfl 5. If dwelling, number o wellin units ............... Number o we un s on eac eot ................ 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...~. ........... Height ~ Number of Stories .c. Dimensions of same structure with alterations or additions: Front ......... -~ ....... Rear ..... ~7 ............ Depth ~ ' Height ~- Number of Stories 8 Di ns/on ofe ti new constru tion: Front Rea -- Depth · me s n re c ....... ff ....... r .............................. Height ~ Number of Stories 9 Size of lot: Front ~ Rear '~ Depth 10. Date of Purchase .......... ~ ........~--. ......... Name of Former Owner ......... ~7 ................... 11. Zone or use district in which premises are situated .... ~'/..~.. ............. ~.~ ....................... 12, Does proposed construction violate any zoning law, ordinance or regulation: . ~_ .6-~x~r ...................... 13. Will lot be regraded ............ .~..q.. ~ ......... Will ~xcess fill be removed from premises: 14. Name of Owner of premises .. ~"'~,~,,(..~---~ .... Address ................... Phone No.c~..~s~'~.."7.~. 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 blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. 'X STATE OF NEW YORK, : S.S COUF. LTAZ-OF ................. ~ ~ .... ........ being duly sworn, deposes (Name of individual sigffing contract) above named. and says that he is the applicant He is the . .' ........... ~ ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 manner set forth in the application filed therewith. Sworn to before me this