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Home My WebLink About10797-z FORM ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. :[0797 Z Permission is hereby granted to: ...... ~7..~.....~.~,~ k~ ~z,~, ..................... .... /2,~,'~-V....~-~7 ... ~,.,~,, ..~ ~o .....~~.....~./.~ ...~//z~..... ~~.. z.~ ............................... ..... ~....~/~.~.,~...~.~ ~.,,.~i~q ............................ et premises located at ~.~7~.....~~.,.~ ...... ~~,.~ ?. .,.~.~....~ ...... .~'.~ ~.% ................................................... ~...~.~ .................. Building Inspector. Fee $..../~..~. .......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..... - · · ' ' ~ ............ 3,q ...... '/' '/ .................................. . ' ~___~ ¢~: '~°'/Ocz 7 /h~ (Building ,nspecror) /.,~,..~o/,-"F,,C~-M//' ~,~rwZ,- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.~. ~. 7 ff7 ....... 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 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 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inJ~ections. ~/'J (Signature of applicbht, or n~e, if a corporation) zz .... ......... (Mailing address of applicant) j~. ); ~Z2- 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 .... ~ ~ ..~. ............ Plumber's License No. ,-7-~...~. Electrician's License No. f'.... ~: ...... /.'. ...... Other Trade's License No .................. 1. Location of land on which proposed work will be done .................................................. .. ...... . . ..... .'d.zT.c. .e. .a. . ,. .g e ..? ......... House Number Street Hamlet County Tax Map No. 1000 Section .../. '.~...~. ........ Block . . ~ ............ Lot.....~..... j. CrQ. ..... Subd,vision...~.~../.~.~P.F'7../[/, .~/'.%'.~.~-. ~..-~..~]". ,~.1~ .... Filed Map NO...ti..~..f ...... Lot.../.'.J3 ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'~I/~/,~'~ /~h"/~ b. Intended use and occupancy ....~..'.~.J./~.../f~' .~....../~...~.g..~. : .~..c4. ('.~.O./.,~. ~ 3 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... " o ~'~ (Description) 4. Estimated Cost ........................ B~ ........ ~.%; ........................ I (to be paid on filing this application) 5. If dwelling, number of dwelling,units ............ Number of dwelling units on each floo ............ If garage, number of cars ......~ ~ ........................................................... 6. If business, commerci~ or mixed occupancy, spec~ ~d extent of each type of use ........ ~W ..... 7. Dimensionsofexigingsimctures,.;ifany:Front~..:. Rear/.~.~.. _~epkh .~ ...... Height ~ ...... Number of Stories . .~. ~.~Y~.. (~... ~. ~ ......... Dfincnsions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... L HeiSt ........ ~.~ ............ Number of Stories ......... ~ ............ Height . , ~.~ ......... Number of Stones . . .~ ................................................. siz o ot: .... ...................... ...................... 10. Date of Purchase . . .~f. ~..' ........... Name of Foyer Owner .... ~~.' .............. 11. Zone or use district in which premises are situated ......... ~ ............. ; ~ ........................ 12. Does proposed const~ction violaie any zoning law, ordinance or regulation: ...~ ~ ................... 13. Will lot be regraded ....... ~ .............. Will excess fill be removed from premises: Yes 14. Nme of Owner of premises . . ~,' .~~. Address ................. ~.PhoneNo ......... of &eho N~e of Contractor ... ~ .............. Address (~R, ~ .... Phone No.~/~.. P~T DIAG~ Locate clearly and distinctly ~1 bufld~gs, whether existing or proposed, ~d, indicate all set-back d~ensions from property lines, ~ve street and block umber or description according to deed, and show street n~es and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF..'~../ff~./'fi'f4 .~..,~.... 'S.S .... ~f};~-~Z~.~,,..]=:f.~f~.~.L/./"~J,f~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann!r set forth in the application filed therewith. Sworn to b6fore me tl~s ' Mer~ora~qdum from . . . . BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD Town H^LL, SOUT~OLD, N. Y. 11971 765-1802 FIELD ~P~mIC~ COMMENTS ~O0~rtON (~s~) FOUNDATION 2. ROUGH FRAME & PLUMBING (an~) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL > 3:0