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Home My WebLink About11806-zeUiLDINO TOWN HALL SOUTHOLD,;N~. Y. COMPLETION OF T~HE WORK AOTH~RiZED) Permission is hereby granted to: S UNTIL ~ULL .......,;~ ...,~[L°t No.'~.~..~.~;.~...~.... Z-- ',i:'~, 19~..~., a'nd approved by the / nspectot FIEL~I~ECTION COMMENTS FOUNDATION (1st) FOUNDATION._ 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTFIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ,z/. ~.t(..~ /( 19~ermit No. Disapproved a/c .............. ____.... - . . ~~ ..... "' '~'~~'~(o;5 .......... APPLICATION FOR BUILDING PERMIT ~ ............ ~9~ ~ ...d~}. ~ ... INSTRUCTIONS a. This application must b~ completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, a~curat~ plot plan to ss~. Fee according to schedule. b. Plot plan show~g lo~ation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and ~ving a detailed description of layout of propsr~ must be drawn on th~ diagram which is part of t~s appli- cation. c. The work Covered by this application may .not be commenced before issuance of Building Pe~it. d. Upon approv~ of ~is application, ~e Build~g Inspector w~l issue a Building Ps, it to the applicant. Such p¢~it sh~l b~ kept on the promises available for inspection throughout the work. ~. No building shall bs occupied or used in whole or in pa~ for any pu~oss whatever until a Certificate of Occupancy sh~l hav~ b~en granted by the Build~g ~spector. . ~PLICATION IS HEREBY MADE to the Building Depa~msnt for the issuance 0f a Building Ps,it pursuant to the Building Zon~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or R~gulafions, for ~ ~onstmcfion of build~gs, additions or ~tsrations, or for removal or demolition, as herein described. Th~ applioant ~gmes to ~omply with all applicable laws, ordnances, bailding code, housing code, and regulations, ~d to admit authored inspectors on premises and in buildings for nscessa~ inspections. ... ~,,.. ff~...S~,~.~. ~.. ............... (Signa~m of applicant, or name, if a corporation) .~P: ~. qsp..~4~... ~:?... ~t~-~ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... .~..~.4...~..~.v. ............................................................ - .C0.~ Name of owner of premises .~ . .&..~q. ,r,r~ u. ................................................... (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. Plumber'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 . .~..i. ~ .... Block ..... ~ .~J ..... Lot. ~ ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~.~¢~$1~ ~[~'~'5 b. Intended Use and occupancy ..... ~:. ~i .... !~ ...................................... 10: 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio~ .......... Repair .............. Removal .............. Demolition .......... i... Other Work..~;e,'9.~.L~.~ . ' (Descriptib~li ' Estimated Cost o-9.~ ~. Fee (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number 6f cars .... ................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............ lteight ............... Number of Stories ..................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth ................... i... Height ...................... Number of Stories ................... Dimensions of entire new cons{ruction: Front ............... Rear ............... Depth ............ Height ............... Number of Stories ..................................................... Size of lot: Front ...... ./.~..o. ........... Rear ...... /.°.0 ............. Depth ....~...3.O. ........... Date of Purchase .......... i ................... Name of Former Owner .......................... Zone or use district in which premises are situated .................................................. Does proposed construction viOlate any zoning law, ordinance or regulation: ............................. Will lot be regraded ........ ; .................... Will ex,?ess fill be remove.d .fro~ premises: Yes No Name of Owner of premises k)di['q-rb..~;~i~ctl'¢.hl-~... Address .~.qgod. O.og? .I~.o~q~:~t~e/(Phone No..o~..~.~.. ~ t .o.t..... ~ Name of Architect ......... i ............. ' .....Address ................... Phone No ................ Name of Contractor ........ I .................. 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 bloc} number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEgLYORK, COUNTY OF. 7.,~...u.:~ .~. .... ~'~ ............. .'~.....~.."~.r.C.~..0~..~.?w .................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ' ' (Contractor, agent, corporate officer, etc.) of said owper or owners, and is ddly authorized to perform or hgve 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 ........ : ..... ~ .... day 9f. · ./?,/..~ ...... ,19~k, ]~o{~,ry cPublic, . .h.. >.~ ..... ~. ~£,.(.. County /~ //~ /