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Home My WebLink About12394-zTOWN OF $OUTNOLD 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? 12394 Z Permission is hereby gronted to: .... ...~..~.~....~..~...~.~..e.,~..... ~.~.. .......... ...~..~./. ........ ...~. ~,~z..~:: .................. ..... ~.~.~..z..~.Z...~...~.~ ........... ~./.~ .... ~o ............. ~..~.~.~.~:........~/..~.~.....~:~.~ ~ .......... :. ........................................................ .................................................................................... ~~.~ ..~/.~Z~....:,. ............... ot premises ,ocoted at ...~..~...~..~.~.~ ............ ..~..x.~..;..~...~.....~'.'.~.~'.~4~.~..~..._~.. ............... ............................................................................................................................ Z County Tax Map No. I000 Section ...~.~.~. ......... Block ....~..2~.. ........ Lot No....Cg.d. 2 ......... pursuant '0 application dated .~..~.~....../.~.. .................... , 1~ ond approved by the Building Inspector. Fee $.,.~.. ~.......-~... .... Building Inspector Rev. 6/30/80 FIELD INSPECTION COMMENTS . =_ ~_ FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ?DE FINAL COMMENTS: ADDITIONAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved. l,('.d/.~...~..S.(~...., 1 .~.. Permit No. ~..~..~:?..~.: Disapproved a/c ........... ~.......?. ....... .,,,~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No..~..'~. ~..~. ....... 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 Cotmty, 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 necessar~g2nspections. ................ (Signature of applicant, or name, if a corporation) · (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .&'. ~ .n:'..7ie.,Y..~ .~.,T. .............................................................................. Name of owner of premises . ,.f~t,a, g~7~,~,~, ,, .(?(~..z=~.. ................................................. (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 ...................... 1. Location of land on which proposed work will be done ...................................... :..... ...... House Number Street 'Hamlet County Tax Map No. 1000 Section ........... ._67. .... Block ........... ~. ...... Lot .... ./.? ...... :'.? .... Subdivision '~ Filed Map No. /( Lot (Name) 2. State existing use and occupancy of premises and intended use crud occupancy of proposed construction: and occupancy O. ro~ ~-~,/'~ff Z)(.o~ I//ff~. Existing use 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .. Other Work...~??.~,?. · ~ :Q/ (Description) 4. Estimated Cost ...... .~.t .)~ .0 .~i ......................... 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 ....................................................................... , 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 ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .... Height ...................... Number of Stories ....................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............. .~ ........................... _. .............. 9. Size of lot: Front . .~.oo~ ....... , ........... Rear . Y..00 ............... Depth ..... .Pq. .......... 10. Date of Purchase .......... ! .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 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. ofO nerof · d,~/o,,,.re ~o l. r'- ?r Name w premises .................... Address .z~... ~/~ .t .......~ .....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 :numJ~er or desc. riptionla~ording to de, and show street names and indicate whether interior or corner lot. ~'-~-"~~ STATE OF NEW_YORK, S.S ........ COUNTY OF .,,f~r,~..,ro~-/& ....... ........... ~.~...,~..~.,C.~.c.qq ~ ' being duly sworn, deposes and says that he is the applicant (Name of individual sign!ng contract) above named. He is the ... ~q.~. F~. ~ rsr- : (Contract)r, agent, corporate officer, etc.) of saig owner or owners, md is duly authorized to F ~rfom or have peffomed the sfid work ~d to m~e ~d file ~is application; that all statements contained ~ this appli :ation are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne~ set forth in the pplication filed therewith. Sworn to before me this ........ ........ ..... :. ~ar~R~ PUBliC. State of New V*~ , [ (Signature of apPlic~t) No. 52-0125850 Suffolk l~rm E~oires March ~0, 1~