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Home My WebLink About12307-zTOWN HALL $OUTHOLD, H. Y. pERMiTi BUILDING ': (THIS PERMIT MUST BE'KEPT ON THI~ pRE4IS~S uNTI,I:. I~ULL COA4PLETiON OF THE WORK AUTHORIZED) ), ; ~2307 Z ~Date ...... ~..,.; .................. 19 ..... ,~..,- Permission ' ~ ........ ~~.:...~..A ..... Building I~spector. Rev. ~6/30 ~ ~o FIF~D ~S?ECTION COMMENTS FOUNDATION (1st) F, OUNDATION (2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qOD~ o FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined ~ ./.~ ..... ,19~ Approved .../~.~.--~x.~.. /...c~...., 1~..~.. Permit No ........ Disapproved a/c ~ . . ~ ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date :V./. ...... 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 promises 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, anabregulations, and to admit auth°rized inspectors °n premises and in building for necessary inspecti(~n;,f~Z~__. (Signature of aplg!~ant, or name, if a corff~,rag4~) (Mailing ~;e~ ~- applicant ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plum/Ser or builder. Naine of owner of premises~. ..................................................... (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 .... y~..~t-6A'~... ~-_e~ .~.~'..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~ ....................... ff.,, .......... ~ ...... i~;~e' mun~~ -" 7 ..... ~ir;;i ....................... I~am'l~ - '~/ ................. County Tax Map No. 1000 Section ............ ~) -~ ~ . ............. Block O ~ .......... Lot... (~ .9. ~ ......... ' ~'~a'~'' '~"' Filed Map No. l! .~.t~. ...... Lot .[.~..~.. Subdivision.. ~..~ £.GYL~..Q,..( ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction! a. Existing use and occupancy...~.e~~.~ ..................................... b. Intended use and occupancy ~ . ..t~.~..~ . (~) Nature (cheek which applicable): New Building .......... Addition .......... Alterat~ .......... of work Repair .............. Removal .............. Demolition .............. Other Work..7V~..~,-q-~..... --]O~C~ ~/6'- (D ripti (~ Estimated Cost ~ ~ 0 0 ' ."~'.. ese on) ............ ~ ......................... 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 ................... J.. Height ...................... Number of~Stgr)~. ~. ~ ................. ( 8'. ) I)imensio~3s 2,f ent, i;e new construction: Front ............... Rear,.... ~,. Q:~f,~c/.g9~ ~ ...... x,_.,, Height . ~J~ ',~-~':4-',' ~ ..~..o.~... f.ad~V...c4..~ ..... ~.f,2-~. ............ 10. Date of Purchase -5 ...... qo. .................... Name of Former Owner .... 1 . Zone or use district m winch premises are s~tuated ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 3 ' 1 . Will lot be regraded ......... /. ~ .... .,-,~ .......... Will excess fill b$ removed Irwin premises: Yes ~? No (~ Name of Owner of premise~7,~*/~zd~.... ~ .... Address ~._,~ ./,/~a7]~4C~, Phone No. z,z. 7. 77..e,.(. f... ......... ! .... ....... Address ..... Phone No. "a .......... 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 number or description according to deed, and show street names and indicate whether ' , ' / d/ , ...... Q .~.. · .~.'. · · ~ ~) .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... : ................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~. 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 ~ UNOA F, KOWALE;KI · .. #OTARY PUBUO, Stat. a[ NOW ¥0[l( , .. ~.../ ................. No, ~.4~ ' // (SignatUre of applic~t) ~ufllllsd In Suffolk County , - [ c ~