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Home My WebLink About12552-z FOR~ NO. I~ TOWN OF $OUTHOLD EllLJlLDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 12552 Z Dote ..... ~ .......................... , Permission is hereby granted to~.._. / ~ v ........ ..................... .... .~..~r.~...~...~ ...... ..4./.~.~.7. ..... to ............. ..4~...~...~..~-Z. ......... :~'.~....q.~. ............................................................................................... Map No. 1000 Section "~'~/"~'"'"Z .... Block .~... '/ cou.~ To× ~. ........... Lot No..~.~.. ........... pursuant 'o application dated .... ~.~. -~.~.~...../....~.<~..: ............... ,19...~....~,., and approved by the Building Inspector. Fee $...Z...,~....~ ..... Rev. 6/30/80 FIELD ~NSP~CTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE COMMENTS FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved//~..f~...~. ~.'' .... , 19~..~'. eerlnit No.../~.dg~..~. · .2~- Disapproved a/c ............ -~ ........... '1' (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 showh~g location of lot and of buildings on premises, relationship to adjoining premises og public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is p£rt of this appli- cation. " ¢. The work covered by tins 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 cod~, and, regulations, and to admit authorized inspectors on premises and in building for necessary ins~~ ~t? (Sigr(~ure of/applicant, or name, if a corporation) /o ./ . . r:. . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ................................................... Name of owner o f premises .. ~.~. -~..~..'~.~..~..~.~..~.~ .~..~. · · · ./.L~..'.~../.~..~ ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nd/ne and title of corporate officer) Builder's License No...._,~o~_~.[ .~. ................ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ttouse Nmnber Street Hamlet / County x Map ..... ....... .... ............ ...... ...... T.;..,;:~a . . No. 1000 Section Block Lot Subdiv. is~:~,__~ .... ...... Filed Map No .... /..x. ........ Lot .~.~/'~ ,~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of p[oposed construction: a. Existin~'Q.se and occupancy .................................................................. · b. Intende use'and occupancy ................................... ~ c ~. r~'~ ,' Nature of work (check which agplicable): New Budding ....... "... Addition .......... Alteration ..... .'~' ' 't' R~pair .............. Rem4vai .............. Demolition .............. Other Work .... ~./"~'....'~..~. ' (Description) Estimated Cost h;~ /~a, o~ Fee ~ [~ ~ ~3~ ~ ~l~ ~t[ ~~ ~OO~g ~ (to be paid on filing this application) If dwelling, number of dwelling gnits ............... Number of dwelling units on each floor ................ Ir garage, number of cars ..... . ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... I. · HeiSt ...................... Number of Stories ...................... Dimensions of entire new const~ction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front .... ~ 2~ ~ .7~ ........ Rear...~ g 7. < .~ [ ......... Depth .~ ~.Q.~ ~.~ ....... Date of Purchase . .~ ~ ~ .... ~ ¢.~& ............ Ngme of Fomer Owner ~..ff~4~ (~'A .... Zone or use &strict ~n win h pr~m~ses are s~tuated .... ~ ~.~ ....................................... Does proposed construction violate any zoning law, ordinance or regulation: ...~.~ ......................... !~ .... Will excess fillbe removqd from premises: Yes Will lot be regraded ........................ Nme of Owner of premises ~e .~ ~ ~[~ ...... Address [~.(q ~ ~q~ Phone No..~.~ ~ ~. Nme of Architect .......... ~ ................. Addres~ ................... Phone No ................ Nme of Contractor ......... , ................. Address ................... Phone No ................ PLOT DIAGRAM Locate cle~ly ~d distinctly fill bu~d~gs, whether existing or proposed, and~ indicate fll set-back d~ensions from e street and blocklnumber or description accord~g to deed, ~d show street nines and indicate whether 10. I1. 12. 13. 14. 3 STATE O F NEW y.O.R~,/~ COUN ~'t'"'~'~a's'i~I~i~}'contract)' ' ...... above named. being duly sworn, deposes and says that he is the applicant (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 conthined 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 ~n the application filed therewith. Sworn to before me this ............. /.~...day o( .... _~..-...., 19 , term Ex?es M~rt~ 31~o I~c- ,