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Home My WebLink About12427-z I~OR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE K£PT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N? 12427 Z Permission is hereby granted to: ...... ~o..:.....~ ....... c~..~ ........................ .... ~.~.~...~.,~, .......... ,..~.~.,... ~ ~o ....... ~~....~.~.......~......~.~,~:.~~.~.~. at premises I~ated at ................................. ............................................................................................................... ~~~ .~ ,.~~.- ....~;~--~ ............ ~z..~ ........................ ~....~ ................... Co~n~ ~o~ ~op Uo. ~000 Se~,o~ .~.~,~ ......... ~k ...OZ ........... lot ~o ......................... ~ursuant to appl~tion dat~ ................................... , 1 , a~ approv~ by the Building Inspector. Fee $.../.....~....~ .... Building Inspector Rev. 6/30/80 FIELD-INSPECTION FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY q DE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~. ~.~.../~..~. ...... 190~.~. Approved r.. .* ..... Disapproved a/c ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 1 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 inspections. · ~.~, q.R/.~/..4~.~.N~ .~...~,.Y,~.~-?, ~ .... (Signature of applicant, or name, if a corporation) ~ .o.,./~:o. ~../~.~f... ~p~ ~m.~.,~>., H~'././. ?.e.(.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~--f~. ¢.~., .~<¢~ ~?...~. ~E,oR ............................................................. Name of owner of premises,~ .'~.. '.zff..4.~ .a~...~.~...t~. :~..-~...~Y .~ed..~.' ..................... (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 ..... ?..~..~.'~. .............. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... .. l~V~ h I~O~O zglPJ-,~,~Uy~ 1. Location of land on which proposed work will be done. ..~. ........ r ................................... · :/.~.. G .~./.;.r~. (?o. t~. ~.. i~../~.?./.~...+., i/-/./../_.~ 7:..~/~.~. ......................................... House Number Street Hamlet . County Tax Map No. 1000 Section ...... .O'.. '.~. ~. ..... Block ..... .(?.! .......... Lot...(~..(~.~. .......... Subdivision...~.~..5~./~. ~.,~...~. ............. Filed Map No...'~( .~..~. ...... Lot .~.K?.: .~?.(.: . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .a. Existing use and occupancy ...... . .t~ ..~../4<,,~.-~..~.-...~..~.~.~....'~. ................ ........................ b. Intended use and occupancy .. C~...~7. ~..~...-~.~ ........ 10, 11. 12. 13. 14, Nature of work (check which applicable '~.~w Building .......... Additiofl .......... Alteration~ .: .....~;. Repair .............. Removal .... ?,,~; ...... Demolition ........ :. Other Work ~.7.-~/y ~. (Description) Estimated Cost ....... . Fee (td be paid on filing this app.lication) If dwelling, number of dwelling units ............... Number of dwelling.hnits on each floor ............ . .. . If garage, number of cars If business, commercial or mixed occupancy, specify nature ond extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .... i .......... Depth ............... Height ............... Number of Stories ......................... i ............................... Dimensions of same structure with alterations or additions: Front ......... ~ ........ Rear .................. Depth Height Numbelr of Stories ti tion Fr R ~ ' Depth Dimensions ofen re new construc : ont ............... e r, ..... : ................. Height Number of Stories .... ! ' Size of lot: Front Rear '"'~,f:" Depth Date of Purchase Name of Former Owne' Zone or use district in which premises are situated Does proposed construction violate any zoning law, ordinance or regulation: . .i. . ./Y?. ............ Will lot be regraded ............................ Will excess fill be rembved from premises: Yes No Name of Owner of premises&°t2.~..~.' .~..~F~..I.~.O' ~/.~..t~ddress /~ g .~ ?.~..~.~ .g I>.77'. Phone No..~.. ?.~..I..ff.l~r' ~%'fs b ~-z-' · .. ......... Name of Architect .......................... Address ............... .... . Phone No ................ Name of Contractor ......................... Address ............ ....... Phone No ................ PLoT DIAGRAM '. Locate clearly and distinetly all buildings, .whether existing or proposed, and:indicate ail set-back dimensions from property lines, Give street and block number or description according to deed, and Show street names and indicate whether interior or corner lot. , ,/, STATE OF NE~'fx'~R:K,/ . C OI}fT~-O~~ .... S.S t o ' iaua~ sTfigning contract) above named. being duly sworn, deposes and says that he is the applicant He is the ....................... · ...~......i.~ ............... : ............... /~.~ontractor, a~nt, corporate office/, e'tlc.) ............. of said owner or owners, and is {~uly authori~orm or have performed th~ said work and to make and file this application; that all statements corYt~ned 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 ........... /.&C. .... day of.. T4ew yorl~ County ': ' · ............. (Signature of applicant)