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Home My WebLink About12187-z TO~N O~ BUILDING TowN, HALL $OUTHO~D~ .U,LD,~~ ~,~ff (~HIS PEPu~IT MU~T BE KEPT ON *HE pR~E~ COMPLETION OF THE WORK AUTHORIZED) ~. ~2187 Z Date, Pen nissioh is hereby granted to: .... Z./.....~ UNTIL ~ULL .,~.,..~ ................................................................... ....,.~...?....~.,:...~ ..... ~.~..~ ....... ~.~ ............ ~ ........................... Cou ty X Map No. 1000 Section ...... ~.~. I ... ..; Lot No. ,.,O.~ ...... BU~I lng I~spector. FIELD INSP~'C2 ~ON FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMEN~TS ~ %, ADDITIONAL COMMENTS: FORM NO. 1 'TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined a~./g ~. ........ ,19 .~..~ Approved .'-.~.A./. .~. ....... 19~..~.'Permit No../..~. Disapproved a/c ......... J ............... ( Application No.. ff..~./...~ .//~. ..... ,/ ailding 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 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 Bm'lding 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectiprts. ~ ~ ......... 5~.~q~.: ... r...-5: .&~ ~ ............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ..../z.~..~?..~./.~ .... .X~:....~./.d.~.~ .z:. ~ ........................................... (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 ...... ~.~/..7~.. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. /./?7/. ..... House Number Street Hamlet County Tax Map No. 1000 Section .... .49..~. ......... Block ....~.. ............ Lot...,~..e>. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... c~..~,g ~.('.~0~ lc.[....ciO~:' ~' .~i:~.~I Q~. ~, t Q. C.(: .~ .................... b. Intended use and occupancy ...... :,ql..~ ~ .~ .... /] .~' .... l,.~;~.t.~.~}}~ ........... , 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .... .~ ......... RemOval ............ .. · Demolition ........ Other Work ............. 4. Est~atedCost..~¢.~... ~ ..................... Fee .~..~ ......................... . (to be p~d on filing this application) 5. If dwelling, number of dwelling [units ............... Number of dwelling units on each floor ................ If garage, number of c~s .... ~ ................................................................... 6. If business, commercial or m~xe¢ occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with ~terations or additions: Front ................. Rear .................. ~Depth .................... ~.. HeiSt .... .., ................. Number of Stories ...................... Dimensions of entire new const~ction:.~ . ............. ....... .............. S' 9. ~ze of lot: Front ......... ~ ........ Rea[( ..................... Depth ...................... Purch s 10. Dateof ae .../..../...7 .................. Nme of Fomer Owner ~"'7 .......... e ............ 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i'. ·, ........ ~ ...... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises ~/~. ~..~/~Address ~5 ~. ~.~ ....... Phone No.~/~r~F f~. Nme of Arch~tect .. Addre~ N~e of Contractor ................................... ............................. PLOT DIAG~M Locate clearly and distinctly ~I1 bulldogs, whe~er existing or proposed, and, indicate fll set-back d~ensions from property ~nes. Give street ~d block number or description according to deed, and show street nines and indicate whether interior or corner lot. STATE OF ~~. ~?X~T~. . .. } .: j .......... being duly sworn, deposes and says that he is the applicant above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authored to perform or have peffo~ed the said work and to m~e and file this application; that ~1 statements contqined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the manne~ set forth in the application filed therewith. Sworn to before me this ......... Nota~ Pubhc .............~.~ ~-. ~ ~ ~[Iza~ ~ ~[[~ .............................................. ~ NO~RY ~UBL/C, State of New Yor~ ~0. 52,812~8~0, Suffotk Cou~,/ T~m E~eires ~arch 30, 19~ County /~ (Signature of applicant)