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Home My WebLink About12113-zBUIlDiNG I Tow~ SOU?He (THIS PEP, MIT BAUST BE KE~T ON i~H:£' p~/~ cOMPLETION OF THE WORK AUTHORIZED) Permission is hereby grant~..~ ...;~,~?..~ ......... ~.~. ...... Mop No. 10aa ~ont ~o application dated ling I~spector. and bpproved by the 'OU~DATION FOUNDATION (2nd) 2 o ROUJH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY ~,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ~×~.~. :/..~..~.....~.7..., ,9~.~ Approved...~7~..~: .... (?..., 19~..~ Permit No.. (.2-../. {..~..~- Application NO.../?: f./.? ......... Disapproved a/c ........... .,-~..=~--. ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ........ /.¢ ..... , 19 .~..~---~ 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 Inspe~ctor. ,~ 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 demolitic n,4,s herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, ~ nd r~gulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~~ , (Signature of p~-~, o n~a~¢,~f a corporation) ~...~. ~o?. . z.~. ~.:. . ..~. .C~. < ~. c?. .'>3. . .~.~. .z/.~. ~.~. . (Mailing address of applicant') State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ................. ....................................................... Name of owner of premises ..~.[.~,?.~...~..'...d/.~..~..(-f.d....'~....~.-:~....~., ................... (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 ...................... .O(.~.~. of land on which proposed work will be done .................................................. ..................................... ~ HamletStreet House Number County Tax Map No. 1000 Section ....~.[.'.~. .......... Block ...... ~..~. ......... Lot.....~.....{..O. ...... Subdivision...,~../{'.~.. r,,.~....~f.~'.~..~ .r.~...~.~¥~ .......... Filed Map No...o~..~'?..~. ...... Lot.. ~. .......... (Name) 2. State existing use and occupancy of pr0imises and intended use and occupancy of proposed construction: a Existing use and occupancy .~. '~.~...~. ...................... . ........................ .................. , ...... b. Intended use and occupancy ~ ~,OQ_,_.~....~(....".0...~.~-?x4,~.,~ ...... .,:~ ~ r ¢-/~ 3. Nature of work (check which a~plicable): Now Building .......... Addition .......... -~Utoratio ............ Repair .............. Rem6val .............. Demolition .............. Other Work....~.t~....~."..... ~ (Description) 4. Estimated Cost ........... : ................... Fee ..../.~.., ............................... (to be paid on filing this application) ~(~If dwelling number of dwelling Units ~ Number of dwelling units on each floor If garage, number of cars ..... ! .............................................. f If business, commercial or mixed occupancy, spec nature and extent of each type of use ............... D~nenslons of existing structures if any: Front ............... Rear .............. Depth ...... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth i Height Number of Stories 8. Dimensions of ent:re new construction: Front ............... Re, ar ............. r. ~ .... :~ ...... :... Height ............... l~m~-i~ +Vp¢ c-P 4~4,~ ~m,...-C'.,5'Z /~,~?./.../../e~-r/ /~,/~- 9. Size oflot: Front .... .~.t.~./F.~. .......... Rear ...qq~. ~f.~. ............ Depth . fl.~..~..~. ............. 10. Date of Purchase ......... .W~.I¢..~(~Y. ........... Nar~e of Former Owner .. ~ ....................... 11. Zone or use district in which prgmises are situated ...... ~.u4.~.t,~.&~.~ .~ ........... / ........................ 12. Does proposed construction viollate any zoning law, ordinance or regulatio'm ...~.~/.~.~. $ .................... 13. Will lot be regraded ......... P ................ Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises ...i.~...~..8~. .......... Address ................... Phone No ................ Name of Architect ........ Zu. '.e~..~-. .............Address ................... Phone No ................ Name of Contractor ....... .A/0Q..t~:-. ............. 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 humber or description according to deed, and show street names and indicate whether interior or corner lot. STAT OFN WY& . :SOD ........... .......... being duly sworn, dep,s s and says that he is the applicant ~ (Name of individual signing contract) above named. He is the ............................................................................. (Contractor, agent, corporate officer, etc.) of sakl 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 contained 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 in the application filed therewith. Sworn to before me this . ....................... day o ....... , P rvy'~qJTAROTO~DO ......................... Nols~ ~ ~r~. o~ ~8~7~o~sw York ~- x,x ~ (Signature of applicant) No. 0~ MI4761689 Quslified In Suffolk CoOnty .~,./ Commission Expires March :30, 11t2~ / ,/ i..0'I' 6 PETER E. 8~ AT MATTITUCK TOWN O~ SOUTHOLD ~{.tF-r-OL K f:'OUNT¥, N.Y. MAR 5~ 1971 BARBARA A. SWAHN REFERENCE, MAP 0~' BENNETT5 POND FILED ~JUNE 12,1970- FILE NO. 5483 ~!/ARANTEED TO,