The URL can be used to link to this page

Home My WebLink About12112-z(~err~issloh is hereb' · TO~OE BuILDI~ $OUYH~ (THIS PERMIT MUST B£ KE~T ON ~ cOMPLETION OF TH£~WORK D~te a{ piremise~ located at ~b~ty Tdx Mop No. 1000 ..... .,,..t ..... portent to ~ppllcaflon det~ ................ ~,..,,~ I~pector. ~ ~ ........ ~.: ............. No~; ....................... and ~pproved by. the FIELD INSF~.CTI~9~N COMMENTS FOUNDATION (2nd) ROUGH FRAME & ?LUMBING %NSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined..~..~./...~. ..... , 19 .~.~.~ Approved ..... l e=it ..................... ":"-'" .... :1: 5 . . ,:. ., .... ~/ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. [ Z/? ~ 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 i~suance 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 6i~ Occupancy i shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance oi a?'Building Permit pursuant to the iBuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or i Regulations, for 'the construction of buildings, additions or alterations, or for removal' or demolition, as herein described. ]'he 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. <,~s+e,~ cu. H ~1 ~12~ .... O~4..gt~c,~..-B~3.kr~..~..6/o~5.. i .~..o.. (Signature of applicant, or name, if a corporation) . (Mailing~afldress of applicanf) State whether applicant is owner, lessee, agent, architect, engineer, general contract,>r, electrician, plumber or builder. Name of owner of premises .('~)~.,k .~. ~.~. ... s .. (~ .......................... (as on the tax roll or latest de~d) If al~ic~nt is ~ corppration, signature of duty authorized officer. ...... .... . ~, (Name and title 0f/j~6i'porate officer) Builder s License No ........ Plumber s License No ....... ~ .... Electrician's License No .... ~.. ~.... Other Trade's Licen~'e No, ./(:. · . ~:'. ~ 1. Location of land on which proposed work will be done... [~..~.. ·, .................... b' ....................... ocli. .................. Hous~ Number Street Hamlet County Tax Map No. 1000 Section ....... '.'~. ....... Block '~ Lot....~.~ .~.. J..~.. Subdivision ............. ](]../~. .................. Filed Map No... ~/./~. ....... Lot ..... ~,/. ~ ..... (Name) I. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~..~. C./:~. ~M~. ~. ..... .~..~./~/. ,. ,~ ................................. b. Intended use and occupancy ........ . .~f/St: .f-~' ' .,/')'~....~. .... .~-..~/~]~_.-~. ....... ~(, ~. ...... 3. Natu~e ofwork (check which applicable): NewBuflding .... ~./~7... Addition ....A4.~.... Alteration ..A4..~. .... Repair .... ~.~. ...... Removal · ·/~/~. ....... Demolition . ./iX. ~ ....... Other Work./~..~.~,f..c.~_~.. ..... ~ 1 ~0' ~ (Description) 4. Estimated Cost............. .................. Fee ...t.g'.:°° (to be paid on filing this application) 5. If dwelling, number of dwelling u~its... I~. ~. ..... Number of dwelling units on each floor, ga if garage, number of cars ..... ~. ~ ........... i" i ........... 6. If busincss, commerciaI or mixed bccupancy, specify nature and extent of each type of use . . . g,(. .,~. ............ 7. Dimensions of existing structuresI if any: Front .... .A,t...~. ......Rear .... ./q.42}r ......Depth . .~..,~ ........ Height ..... ~ Pr:. ..... Number of Stories ..... .~. (.bT ............................................. Dimensions of same structure with alterations or additions: Front ... Aa..,% ......... Rear .... .~q. e'~ ........ Depth ...... ga../~.: .......... i' Height ...... ~..<~.. .......... Number of Stories..4z.,,~ ............... 8. Dimensions of entire new construction: Front .... ~ egr. ....... Rear .... .'~. .4-r'. ..... Depth ....,~.,x,?~ ....... Height ...,q(/.):'7 ........ Number of Stories....,~/.".2?7.-. .............................................. · ' pth 9. S~ze of lot Front ..... Rear ..................... 10. Date of Purchase ... : ·: ................ Name of Former Owner ........... 11. Zone or'use district in which premises are situated ............................................... / i 2. Does proposed construction violate any zoning law, ordinance or regulation: .... A.~.(.~ ....................... 13. Will lot be regraded ..... ~/,.0..i .......... , .......Will excess fill be removed fro,m premises: Yes 14. Name of Owner of premises .O~.TtS.~G~.. ~.~&kJ.~.~.,tlq~dress . .k~./.~!¢:..~..~...0(-((,V?Phone No. Name of Architect ....... N .'q'. ............... Address . ~ .0:..~.of..7..~ .... 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 nhmber or description accordifig to deed, and show street names and indicate whether interior or corner lot. 5TATE OF NEWJgOR~, -- s,s ....... ~,~,,~~. ~,~..~...~ ~'~L~. ............. being duly sworn, deposes and says that he is the applicant .. (Name of individual sigffi~g c6ntr~ct) ' there named. ,~e is the ........................................................................ (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly ~authofized to perform or have perfo~ed the said work and to m~e ~d file this ~pplicafion; that ~1 statements contaioed ~ this application are tree to the best of his knowledge and belief; and that the york will be Oerfomed in the m~ner ~et forth in the application filed therewith. lwom to before me t)i~ .......... ~...W ...... day of.~...~~, 19~1 ta~ ublic, .~¢ .......... ~~.. County t lh ,/I JUDITH T, TE~RY