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Home My WebLink About12514-z FOIt~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12514 Z Date ................................ 19, Permission is hereby granted to:~ ...... .&..~~.~l.,...~..:.~.~ ........... ,o ..... ........................ at prem,,es located at .......j.....C~,....~j. ................. _c:.~....,~...~ ........... ?...~. ............ ..~...:~..~s..~.....~ ..~ ...... Block ......... ~ ......... Lot No ........~...~....~. ...... County Tax Map No. I000 Sectior~\......(~......(~.~ C~ J 19~.~.., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FIELD INSPECTION FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL )ATE COMMENTS ADDITIONAL COMMENTS: FORM NO~ I ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined..~k.~...~...'.~. lC.., 19 .~.~. Approved .~,c~3~~. ...2~.~.., 19 .~.~. Permit No.).~.k~.].~..~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... 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 admit authorized inspectors on premises and in building for necessary inspe~..--~ .~ ~_~.~.. - - '0~ling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ .............................................................. Name of owner of premises...~ ~.~.~..~~...I...~.(?./ ........................................ (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 Street ~J Hamlet County Tax Map No. 1000 Section .... ~ ~0. ~27 ....... Block .................. Lot ................... Subdivision ..... .~'. .............................. Filed Map No....~ ........... Lot. ?. ...... !/. .... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstr~cti~n: a. Existing use and occupancy ............... '...:.:..;:.. ~.:. ~. ....................................... b. Intended use and occupancy .................... ~ ....... ~. .... ~ ...... ~'. .......................... Nature of work check which a cable: New Building Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work .~t.c ~ *,~q .... /~ /' / (Description) f,stnnated Cost ...................................... Fee ...................................... : (to be paid on filing this application) 5. If dwelling, number of dwelling ,,units ............... 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 structur0s,if any: Front ............... Rear .............. Depth ............... Height Nunlber of Stories Dimensions of same strncture with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ........ t' "r/' ·" ...... Number of Stories ..... (~ Dimensions of entire new construction: · ........ ~ ........ .. ~;~...~.'.. Jaa[~, Rear ............... Depth . .~.... Front 9. Size of lot: Front ......... : Rear Depth 10. ~ate of Purchase 'i ......... ; ........ i ~'a ....... Name of Former Owner ............................. 11. Zone or use district n which pr mises are s t ted ....... ~.. ............................ 12. r)oes proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ ~, ......... ~ ......... Will excess fill be removed from premises: Yes No Name f Owner of premises ...,l~..kM, V.~ ..... Address .[.°[~.O. .... Phone No. ]7..6.~'..~.~..~6~.. Name of Architect .......... i ................. Address ................... Phone No ............... ,. Name of Contractor Address ' Phone No 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 interior or corner lot. (Signature of applicant) ou ,y ' ~RY PUBLIC, State ol ~w Y~rR ~, ~-8125850, Suffolk CO~.~ ~rm ~pires ~rch 30, 1~ STATE OF NF~'~RK;,..r~ S S COUNTY~ ~- ~ o'd,lj,'~j~~s]gn~ being duly sworn, deposes and says that he is the applicant He is the ...................... !~. ~ ..................................................... (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 cont~ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne,r set forth in the application filed therewith. Sworn to before me this 4