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Home My WebLink About12648-z FOBMI NO. 9 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. (THIS pERMIT MUST BE KEPT~N THE PREMISES UNTIL FULL COMPLETION OF THE WORK A~IZEO) N9 12648 Z Date I 19.~.~ Permission is hereby granted to: ......... ....__..............._........_~.:.:..iii"i'"iii'"i'i'"i'"'"~511111 iiiii ii iiiiiiiiii iii~ii ii CoUnty'T_qx'M~'N°'"1000'Secti°n ..~.'..~..':..t'..~'. .......Block ....... .O....~. ........ Lot No ....... ..q). .............. pursu(~nt t~.--..~...~ .......... , 19.'~:.~, ond opproved by the Building Inspector. Building Inspector Rev. 6/30/80 FI~LD~NSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ; DATE COMMENTS ADDITIONAL COMMENTS: ,f FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined~.~..) ..... , Approved..~..~...., 19~.~.. Permit No. ~ ~s 04) ~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application nmst be completely filled'in by typewriter or in ink and submitted in triplicate to the Buildi 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 st~e~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may not be comnrenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applic,~nt. Such peru 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 Occupan shall have been granted by the Bnilding Inspector. APPLICATION IS HEREBY MADE to the Buildh~g Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or.for removal or demolition, as herein describ~ The applicant agrees to comply with all applicable laws, ominances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. . ............ {Signature of app~nt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ............ .~...~.?.4.'g ........................................................................ Name of owner of premises .... / (as on the tax roll or latest deed) If applicant is a co]poration, signature of duly authorized officer. (Name and title of corporate officer) Plumber s License No .......... .~.. ........... / Electrician's License No ........ .~.~ ........... Other Trade's License No ...................... Location of land on which proposed work will be done...C'/~$..Z'.. ~.../~.~....~..~.~..g?....~.O.~..~. ............ ·../.~o.7..5. ....... /~. ~.z.~.,r...~..~. ............................. ~.~.r_.~. ~. c~. House Number Street Hamlet 75 - d. County Tax Map No I000 Section ' Block Lot · Filed Map No Lot Subdivision .................................................................. (Name) State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......c'../Y.......~ ,..:::.......- .....-~....'-- . ......................... .. . b. Intended use and occupancy ................................................ 3. Nature of work (check which a cable: New Building ...... Addition .......... eration .......... Removal ' Demolition Other Work Repair ......................................................... (Description) ~. Estimated Cost ......................... · · · · , ............................. ~' ........... ~ (to be paid on ~ing this application) L If dwelling, number of dwelling Units.. ............. Number of dwelling units on each floor .......... If garage, number of cars ..... . .................................................................. L If business, commercial or mixed occupancy, specify nature and extent of each type of use . · '~''' · ''~' ............. 7. Dimensions of existing structure~, if any: Front .... 7.O. ........ Rear ... ~..O. ........ Depth..~ .6,. ......... Height .. Y..7.~ ......... Number of Stories ...... / ................................ ................. Dimensions of same structure \riCh alterations or additions: Front ... ~ ......... Rear ...~:%~. 2 ............ t. Dimensions of. entire new constrhctlon. Front ..... /~. ....... Rear .... /. ~. ........ Depth ./~ ........ Height ~)~.~ Number of Stories ]. ' ~. Size of lot: Front ..... 21.0.0. .[ ........... Rea.,' ..... .2..0..0 ............ Depth ../.~. .............. ). Date of Purchase .............................. Naml~ of Fort. er Owner ............................. (mises a 'situated 'e/~_q/~£d2"~ 'l' I Zone or use district in which pr re ......... ~ L Does proposed construction violate any zoning law, ordinance or regulation: ..,,~.~. .......................... I. Will lot' be regraded ......... ................... Will excess fill be removed from premises: Yes No Name Of Architect i// Address q Phone No. . Name of Contractor it Address *' Phone No ti PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lin'es. Give street and block nmnber or description according to deed, and show street names and indicate whether ~terior or corner lot. - ~ ) rATE OF NEW YORK. ..... (Name of individual signing contract) hove named. ie is the (Contractor, agant, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed tire sa. id work and to make and file this 9plication; that all statements contained in this application are true to th~ best of his lamwledge and belief; and that the ,ork will be performed in the manner set forth in the application'filed therewith· worn to before me this No, 52.4524171 .............. I~ualtfied in Suffolk County ': ~/~" ~/ (Signaturo of applicant) Commkssion Expires March 30, 198~ DATE:/.~)'h~ B,P, FEE' J~,. %...BY: ____~ , NOTIFY B' HLDING DEPARTMFNT A~ 765-]8n~ 9 AM TO 4 PM FOR THE FOI L~/ING INSPECTIONS: 1. FOUk~mATION - TWO REQUIRED FOg PqURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 4. FIb~A~ ~ C~N'S~PU~'r'ION MUST BE r ..... ~?-E FOR C O. ALL C~?cmR~}CTION SHALL MEET · HE RF~'n?EMENTS OF TFJ5 N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, -f Il U .,Fli r L oO [-~ lP L.~NN