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Home My WebLink About10910-z BuILD!N~ BUILDING (THIS ~RMIT MUST BE KEPT ON THE COMPLETION OF THE 10910 Z Permission is hereby ~lranted to: UNTIL FULL of premises County Tax pursuant to apl Building Inspector. Fee $ ...... Rev. 6/30/80 TOWN OF SOU~OLD O?F~CE OF BUiLDiNG ~NSP£CTOR · P.O. BO,~ 725 TOWN HALL $OUTHOLD. N.Y. I L~71 TEL. 765-I 802 - App!ican~ P T,his is to advise you chat the ~.% ,,~'o = .... erm~t 14o../~Io issue~ to -- : o~,~ .... r ~uz!C~ng In order to come!ere this f~!= it is ~= =~ -, ~-- .-ll out ~ne O.._c. wash a check fo~ $5.00 payasie to the Town of Southo!d. F!e~se indicate to whom the Certificate of Occupancy is to be mailed, and a~range wlth thls offlce fo~ an inspec[ion date. Thank you for your prompt a~ten~lon. VL:ec Enclosures Very truly yours, Victor Lessard ~dminia ~.r~ 5or COMMENTS F'£E%D ~INSPECTION !- FOUNDATION ( 1 s t ) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONA~ CO~, ENTS: TOWN OF SOUTHOLD BUILDING D£PAFITNI£NT TOWN HALL SOUTHOLD, N.Y. TEL.: 765-1803 Approved d~.C~.? ~ ~ )C ~, ~. C ....... Disapproved a/c ..... .~ -.~-.-~ .................. APPLICATION FOR BUILDING PERMIT Date...'./ .... ~ :V~ ......... 19 .~.~.' 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 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 inspections· ..... ....................... (Signature of applicant, or name, if a corporation) ........ (M'ailing ~lti;e's} o~'a~3ii~r~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ................................................................................. Name of owner of premises...~.4f.S.....4~.~. .P(...?(.~...q.~.: .......................................... (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....~...O~..d--.g.~...,~. ........... Plumber's License No ......................... Electrician's License No ................ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. 2 0. ........ ?. .( .... . : ......... )/.e. .47. ,:/.¥. ................. House Number Street Hamlet County Tax Map No. 1000 Section .... /./. -7. ......... Block ..... 0. ~ ....... Lot...~. ~ ............ 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 . .0. !~..~..¢~..~../.? b. Intended use and occupancy ....... ~../. ..... . ............... 3. Nature of work (check which applicable: New Building .......... Addition ......... Alteration .......... Repair .............. Removal ... i ........... Demolition .............. Other Work ............... (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 ........................................................................ 6. If busine.ss, commercial or mixed occupfincy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any:: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase .............................. Name of Former Owner ............................. Zone or use district in which premises a~e situated ..................................................... Does proposed' construction violate any !zoning law, ordinance or regulation: ................................ Will lot be regraded ............... i ............. Will excess fill be removed from premises: Y~es No Name of Owner of premises t~.~.,.. ¢g'P.~?. ¢.' ...... Address~r4>fd..~o.~f..~..G/: .... Phone No. 7.~ .g..O'~' .~.. ~.. Name of Architect .................. t .......... Address ................... Phone No ................ Name of Contractor ............... . ........... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildin:gs whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block numberi or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y.-tORK, .... COUNT)/OF '. ..... ....... .............. (Name of lndlwdual s~gmng contract) above named. being duly sworn, deposes and says that he is the applicant 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 manner set forth in the application filed therewith. Sworn to before me this ................... day of ......... ,19. Notary PuNk:, . ..... Ccunty i No 52-4~24771 (Signature of applicant) Qttalitled rn Suffolk County