HomeMy WebLinkAbout12318-z TOWN OF SOUTHOLt~
BUILDING DEPART~E~NT~'
TOWN HALL
Y
SOUTHOLD, N.
BUILDING' PERMiT~
(THIS PERMIT MUST BE, KEPT 0N~HE PREMIses
COMPLETION OF THE WORK AUTHORIZED)
UNTIL ULL
Building Inspector.
~ee ..... /..~ ..........
Re¥. !6/30/80
FIELD INSPECTION COMMENTS
FOUNDATION (1st)
F,OUNDATION (2nd)
2.
~OUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .~, ./~ · .~ · .~.., 19 .?.'5~
Approved. A'.c~.'.~.~.... '~' , 19 . .~. Permit No./.~..'~./.'..,~.Z
Disapproved a/c ......................... ./~ ........
................................ i~
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No.../.~..~.. ?..~.. ......
Date .. ~//// .......... , 197.~.
a. Tiffs 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 promises 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,. .~ / //~
..... .................
(Signature of applicafit, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises...~./.~.~'...~...,~...~..c~. ..... ~ ./~..../~. ...................................
(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/~ o o ,~--oew-I ./~'''~' Street Hamlet
County Tax Map No. 1000 Section..~.~..~.. ......... Block....~..~ ...... Lot..t~...~ .............
Subdivision ....... ~.. ............................ Filed Map No .... /~ .......... Lot . . .~. .... . .......
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy. ~..'~. ,~...~..~..~./.~.'..Y...~.c..~.~./..~.&~--~'~
b. Intended use and occupancy ....~...~...~........'~......~...~....1~-..
3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration ..........
Repair ........ i ..... RemOval .............. Demolition .............. Other Work. ~. ~. ~.~. ....
Lst~mate ost ' Fee ...........................
[ (to be paid on filing this application)
5, If dwellmg, number of dwelling~unit~_~. ~ ..... (! .~.. Number of dwelhng umts on each floor ................
If garage, number Of cars . .~t~. &. ..............................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................
7. Dimensions of~ existing structurds, if any: Front . ~ ~..'~. ..... Rear ~..cY~/T ...... Depth..~.. ~..~.
Height ~ .'~..t7 : Number of Stories .,/:/.z~...%. ................ /.i ..................
Dimensions of same structure with alterations or additions: Front ....o~..~. ...... Rear ...~....~J-'A~...~Y ........
· Depth .... ~'F~¥.~- ....... :.. Height ....-~....'3T'~....~. ..........Number of Stories...~-.,~..~? .~.'-. ............
8. Dimensions of entire new construction: Front .......... Rear .......... Depth . ..
Height ... : ......... :, Sto, . 2 :. ::: ......... : ...... :. :.
9. Sizeoflot Front J~)~..~. .. l~ear../.~..D..~.. Depth ,/.~.~9~'~. '
,u /~, t ~£~ ' ' '~-- ' .......... ',~ .........
10. [)ate of Purchase ~ .... I ..... '.'".'. ........ Name of Former Owner . ~..q~..~Y. .... ~..&~./.. ?. ......
1 1. Zone Or use district in which premises are situated.. ~/7... ~J~.. ~. ........................................
12. Does proposed construction vioiate any zoning law, ordinance or regulation: ../~.~. .........................
13. Will lot be regraded Z~..~...~ .................. Will excess fill be removed from premises'
14. Name of Owner of premises .~?~?...~..~..'~. ~... AddressZ.~.e. qYf. f.,?.,~... ...... Phone No.' .'/. ~."(..../?.~..o....
Name of Architect .......... ................. Address ................... Phone No ................
Name of Contractor ......... ................. Address ................... Phone No ................
interior or corner lot.
PLOT DIAGRAM
Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block humber or description according to deed, and show street names and indicate whether
STAY~ OF N~W~Om~ .
COUNtrY OF. f~. ~.~-~q~..~.....
......... Dq
(Name of individual signing contract)
above named.
being duly sworn, deposes and says that he is the applicant
He is the t~-c)/~)
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly 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 m~_this
//t~7~ , . ./~...~../..C7 19~
........................ day ofi .......... , ...
Nota~p_Pu~blic,...~...Z~. ~)~.~-~x%...i'. ......... x ...... County
...... ...... . ........