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Home My WebLink About12372-z FOI~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12372 Z Permission is hereby granted to: ~ ...... ~ .~..~...~. :~.~.~.~ .................... ........ ~.~.....z~.~.~. ..................................... ....... ./...~.~.,.~..~.z .~..~.~, ~.....~....~:. ........ ~o ........ .~.~.~.~..~..~:.....~...:....-~.....~.~.....~,-~-~........~.~-~....~ ........ ..................... ~.~,~....~...~..~z~~:.....~.~.~:~~.z~ ...... 0, premises located at ...Z~...~..~........./,,~..~...4.~....~....~/o. Zc~......~~ ......................... ................ / · · ~~..~..~-/'~4, ~- '~ County Tax Map No. 1000 Section ...Z.~... ........ Block ..... ~.....~... ...... Lot No.....~..../.Z .......... pur, uont ,o app,,cat,on da,ed .... ~...~.. ...... Z~.. ................... , ,~ ond opp,o,~ b~ t~e Building Inspector. Fee $.../... ......... : ...... 'Building Inspector Rev. 6/30/80 FIELD IN'PElION COMMENTS ~' FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1~0~ Examined .~r...Z. .... ,19~.~ Approved ~/¢.~... ~. ..... , l~...~ee~mit ~o. · ./..~?. ~..~.y Disapproved a/c . . ;~.. ~ .............. x. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 in~t~rf~ ~,~,~ ..~,~... ......... ¥~.~;~;'~;;,';;a' i~ .... (~r'i';i~licant,.orname.,ifacorpc t' ) .... ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ¢~ ¢.v.:~;~.,~.~;,.,~.,;;/~:,~:: ............................................... .......................... '~ £u..~..~..~. ~. ~..~ .k~.:~ .~,... Nameofownerofpremises . .'~, ........... ~. ..... ('a's~'n';~;';ax roll o~atest deed) r~ {~e~' {~t~:~ If applicant is a corporation, signature of duly authorized officer, x'~'~{~c ~ "'~ (Name and title of corporate officer) Builder'} License No. ; ,.,. ..................... Plumber s License No...~ .............. Electrician's License No ....... ~,~ ....... Other Trade's License No ........... '~'x~' 1. Location of land on which proposed work will be done .................................................. .../x ~a ........... 'AS ~ .~..c ~.~....X..~:~. ......... . .l/Y. ~.t. ~..~.~.. k ............ House Number ~,) Street Hamlet County Tax Map No. 1000 Section.../.~o~....~. ~ ...... Block ~ Lot .~..?. ...... Subdivision.~Y~.O~r..~.'~."..,O~.~.~..(~.~..... riledM~;'~i' ii[i~iiiii... ~il...I.~ ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy../..~-'~.... ~...&~. .................................... b. Intended use and occupancy .... .V. ....~-~..,4, .... ..,~4-:-.~..,~¢,,,~,~: ...... .~.. ~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval. .............. Demolition .............. Other Work 6_.,.~,~. ~ ...... 4. Estimated Cost .......................... Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwelling iunits .............. Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................. 6. If business, commercial or mixed occupancy specify nature and extent of each type of use ......... 7. Dimensions of existing structurgs, if any: Front ............... Rear .............. Depth ............... tteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... 2.. Height ...................... Number of~qtories ...................... 8. Dimensions of ectire new constrUction: Front ............... ,Rear ... 2 .O.f. ...... Depth ..... Height .... ,g .......... N ~,,~, v, otw,~ .. ~,~. t..-~tT.. ~(2A [ ....................................... 9. Size of lot: Front .......... 2 ........... Rear ...................... Depth ...................... 10. !)ate of Purchase .......... : .................. ,N~amej~f Former Owner ............................. 11. Zone or use district in which pr~mises are situated .... '~'k...% .~..'. ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. NameWill lOtofbeownerregraded ........ ~,~.-~- ,, ./j/. r?; .............. Will excess fill be removed from premises: Yes No 14, of premises ~ .-~.(/-,~.3.~...o't,C.... Address ................... Phone No .............. ..- Name of Architect ' '/~-'" ' '~'~'~.(O' .h: .E4~..' i~ ...~,...~i i .* Address ................... Phone No ................ Name of Contractor . Address ./~.~. !( .g.~. .......... Phone No. ~ ~J~. ~.~..~..¢~r77.. PLOT DIAG RAIVl Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block :number . or descfi~p~tion according to deed, and show street names and indicate whether interior or corner lot ~) ~ C) t/~ t/ COUNTY OF~.~...~ ' ........ :l~ .... ~..... being duly sworn, deposes and says that he is the applicant 1 signlng contract) above named. He is the ................. . .................................................... ent, corporate officer, etc.) of saki owner or owners, and is omy autoform or have performed the said work and to m~e and file this application; tkat all statements c0nt~ined ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ~" a f~ ~ ~ .......... ~ ....... d yo... ~.~ ....... ,19.~ Nota, Public,. .... ~ .... ~..~~County ~ 40~??uc st~[~ o~ u~0u~ (Signature of applic~t) N at.8~258~, S~folk Cou ~;m ~x~ires March 30, ~9~ /