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Home My WebLink About10999-z(THIS PERMIT MUST BE KEPT ON TH,E PREN COMPLETION OF THE WORK AUTHORIZED) N? 10999 Z SE$ UNTIL FULL Date - ~ / 19 Permission is hereby granted to: ~--/'/'~,~C~ /(--/~,~ ~ ~, · .,~.~:.7.~ ......... ~.~c.~,~ ........ ........ ~.~. ,~, ..... ~ .............. ~o ....~.~2~.~.~.~. ........... ~ ................../ Z~....~; ....~ ~....~.~ I;. : ~ ~o~,~.,o~ ~...~...~. ~....~.........~4~.= ........ ~....L~c~/~x .... ~ . .~:.~: .... : ........... ~ ............ ~.~.~ ............ ~ ........ = . co~a~ ,~ ~,p ~o. ~o0o s,~o~ :..c~Z. ........... *~o~ ~?..,~.~ ......... [o~ ~o. '"¢~'-7 ......... pursuont to ~pplic~tion doted ...... ~. .......... L.~-... ...... :.~....., ] ~j.~ *nd ~pproved by tho Building I~spector. }; Inspector FIEJ~D I~SPECT ION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY co E FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined~.../..~.~..., 19 ~ C' Approved .0~..3~-~<.....{.~J , 19~...d. Permit No. t/~.. ~..~..t. ~.~ Disapproved a/c ................................... 7.. (Bffildiffg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 drown 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 issue 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 ail applicable laws, 9rdh~es, building code, housing code, and r~gulations, and to admit authorized inspectors on premises and in buildings f{)r necessary inspections./~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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... ~t.~..?.'-~-..~:./C.. ~.~ ~ / ~icense No ......... ./. .......... Plumber's Electrician s License No ..... ~. ............. Other Trade's License No....( .................. 1. Location oflan~d~on which proposed work will be done. . . 7~/~. ........ 2,~B...L:./) ..... .... ................................................... House NumberStreet Hamlet County Tax Map No. 1000 Section ...... (~.7 ........ Block ....~.? ............ Lot. O ? ~ Subdivision.../.~ .'..~.-...~..W..x~..~...-}....~.~. c.../j.~.... Filed Map No./.5. .~. ......... Lot.7.~..~.. ?..~. .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~J..~.~... O~. +~...~.~..~/'. ! ~ ~ .......... · ............... b. Intended use and occupancy ...... ~ .~..~...,~.~..,~.*.....~.....~.~.' .~:..~..'~....~.'..~..~r.~?/.~:J....~.~..~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio~ .......... Repair RemOval Demolition .............. .............. .............. Other Work..x~. t~-~. .... : .~..~..~.. ~' ~ ~ ~ ~ (Description) 4. Estimated Cost ........................... 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 cars .... ; ................................................................... 6. If business, commerciai or mixed occupaficy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... lteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth~ ................... ~.. Height ...................... Number of Stories ...................... 8. Dime~sions of entire new constmction: Front ............... Rear ............... Depth ............... l~eight' ............... Number 9f Sto~es ............ ., ........................... ,../.~ .......... 10. 11. 12. 13. . N~ :of Architect .......................... Address ..................... Phon~ No .............. . Addressff~((T/d ~.~ ..... Phone PLOT DIAG~M Locate clearly and distinctly ~1 buil'd~gs, whe~er existing or proposed, ~d, indicate all set-back d~ensions from property lines, Give street and blockinumber or description according to~~w .... ~s and indicate whether STATE OFiNEB~-yORI~, ,~d :. COUNTY OI~-~....:~'~ ...... <~..~,~t,~e~-~......~?...~-~e~. being duly sworn, deposes and says that he is the applicant · (Name of individual sig~ing contract) above named. 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~fined 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 : No. 52-8125850, Totm Exoires March~130, lO, q-