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Home My WebLink About12339-z TOWN OF sOuT"0~D BUILDING DEPART,MI!NY TOWN HALL SOUTHOLD, N. Y.. BUILDING PERMIT! U'HIS PER~IT ,MUST BE KEPT ON THE PRE,MIS iS UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) N'° 12339 Z Do~e Permission is hereby granted to: ~ , ...... ....... ~,.....~......~... ~..f.. ........... ........~ :~~~.~....,~..:~.,.~- ~ ...... , ........ ,o ....... ~~......~ ......... ~.~..~~, ~..~~ at Premise, ,~ated at ......... ....... :~.: .......... ................................................................................................ ?...,..~~...~...~.~/. ~u ~p No. ]000 Section ............. Bilk .......... ~Lot No ............. . ..... ,~ai~ '~i;~ ......................... Rev, FIELD [~SP'~TION COMMENTS FOUNDATION (1st) F,OUNDATION /2nd) 2. ~OUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 Examined. ~.'.~.~.. ~c. .~..., 19 ~..~ I %ermit 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 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 ~tspections~. ~ (Signature of applicant, or name, iffa corporation) ~' (Mailing address'of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general~0~electrician, plumber or builder. Nameofownerofpremises .'/~.~.~....9~.~.&...*f~y....~. .... .~.~.~....~..7. )/.'~'~ !'.(~.(/~.tft. ~' [. ~:'~f.~ i~ 'q .~ (as on tlge tax ro'li ;; latest ~;id') ...... ~ ..... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... .... ....... / va s r. . . ...................... House Number ~O ~ ~ir'e;i ';~', ......... Hamlet County Tax Map No. I000 Section ..... ./. (.~ ....... Block....0...~. .......... Lot... (~../Z .......... 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 ....... ~.?.?.?.~./.(.q/.x. .................................... b. Intended use and occupancy ............ /..t' .... ~....~..~ .................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratign .......... Repair ........ Rempval ........... Demolition .............. Other Work ~. ,~5"~/. ~_~.... 4. Estimated Cost ..... r ~.. 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 .... 2 ................................................................... 6. If business, commercial or mixer occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ifany: 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 ............... tteight ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... : ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulatinn: .................. ./.'( .~. .......... 13. Will lot be regraded ......... : ...., .............. Will excess fill be removed fr~m premises Yes No 14. Name of Owner of premises /7//.Z. /.(...~../~. ...... Address/.?./..(.1~.~..~.~.~?.t(~hone No..77...~'.-..~..~.q.7... Name of Architect ......... ! ................. Address ................... Phone No ................ Name of Contractor ......... ! ................. Address ................... Phone No ................ PLOT DIAGRAM 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 description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ]~RI~,/ . / i,, COUNTY OF .~(~--2t~'~q~t~v-,t--~'~ .... ,/~~~,~,~,.c.~,.,,~./,~ .......... being duly sworn, deposes and says that he is the applicant above named. He is the ...................... ' ................................................................... ,, : (Con,actor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work ~d to m~e ~d file this application; that all statements contained ~ this application a~ true to the best of his knowledge and belief; and that the work will be perfomed in the mmner set forth ~ the application filed therewith. Sworn to before me th¢~ .......... ~ ........ eta, ublic,~ ~~..~~-. County ~ No. 52-0344983 o.~: .... ' Commission E~,ire~"u~Y ~gun~~ (Signature of applic~t)