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Home My WebLink About10628-zFOUNDATION FOUNDATION 2. ROUGH PRAlVIE& PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY c0~E FINAL ADDITIONAL COMMENTS: FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10628 Z Permission is hereby granted to: ....... · ~.'-~..~..~r..z....d.Q...~./...c.'..~.~ r(~ ..~.o....,P, oo.././....C~c~.z.r..: .......... ...zz .%.. .... ~.c.~c~M..~......~o ...... ~ ~... ~.~ ....... ~[~.~ .................................... ........... .O~.~..d 0 .............................................................................................. 13uilding inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~? C,4'~ 6'3-t5,O O,k~Z ~.~ 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 g~ving 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 applicatxon may not be commenced before issuance of Building Permit. d. Upon approval of th~s 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 ~n 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 Bmld~ng 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 premxses and in buildings for necessary inspections. · ............... (Signature of tYpplicant, or nam[, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ... (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 .... .~..y..~.~.t?.(Z.~.T~.: ...... Plumber's License No ..................... Electrician's License No ..................... Other Trade's License No ..................... 1. Location of land on which proposed work will be done..~..~..,~.d~../..~.-~..~'.' .(.~..~.~..7C...67..cc.x~.~.. ~.~.~ ........ House Number Street Hamlet County Tax Map No. 1000 Section ...~4f~ ........ Block ...[ .............. Lot ~// Subdivision ~~ ~Z~. ~Q~Qe~/~i~ .... Filed Map No...~. ~ ........ Lot ~/~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exishng use and p y ........................................ ~-: .... :/ ..................... b. Intended use and occupancy ~ ~/~/~. ~/~/~ ~ ~<~'~g~ 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '~ t~, '~ O~ ,~7~-t~- ~ (Description) 4. Estimated Cost ..... Z,~..t~..~ ......................... Fee... ij~..~.~. .......................... (to be paid on filing this application) 5. I f dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... 4 ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. 1)nnenslons of existing structures, if any: Front ..... .~.P. ...... Rear ./~. .......... Depth....~. ~ ........ Height .../,~..t ......... Number of Stories ...... ~./~..~". ............................................. Dimensions of same structure With alterations or additions: Front .. c~.t?..~ .......... Rear .... ./~ ./ .......... Depth ..... .~. ~. ~. ......... ,.. Height .... ./~'f. .............. Number of Stories .... ~ .~/.~.'~ ............ 8. Dimensions of entire new const[uction: Front ...... ./.~'. ......Rear ...... ./.~. ...... Depth . ~. ~, .......... Iq[eight . . 1/. Number of Stones ,.~ ~'.~t,~ '-'~t~,~t ~ 9. oize of lot: Front ~..o .~.~..~ ~..Zf~. ~/l .p. ~ ( .~.~.e. fi~C.~..~%~.c!~' .g?.'.... D~I~ ...~..~.~.~. ~. ~..~. ~.~'T_~.,.. 10. Date of Purchase .... ~. ~,~-. :i~.~. ............... Name of Former Owner .~.~.,~.~,r. ?.,.~.~?/~..,f/.~.~'~. ...... 1 1. Zone or use district in which pr~mises are situated ....... /,~.,~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ,AL~. ...................... 13. Will lot be regraded ...... /!/,~ ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .2f.,~p.~.~.~{..~.~.v.~/.Z/. ..... Address /.~.'g'..'g'.~.~A .c.~z..~.r. .... Phone No. ~..Z.g'..?.*.' .a.~ .... Name of Architect ......... i ................. Address ~../.~.~..~.'~...~.Z.~, .~.'... Phone No ................ Name of Contractor ........ i ................. Address .././.~.~. ............... A/.~., 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: number or description according to deed, and show street names and indicate whether interior or corner lot. , (PluLC/ , ~,. STATE OF NEW Y~. P>~,. ~/., , ~ ~ ~a~'~'.~il ~t?~i'.~ being duly sworn, deposes and says that he is the applicant · ' '~l~'g~' g ) above named. .~,~./q.//.~. He is the ....... ~..~...~.. .... '.., .............................................. (Contractor, agent, corporate officer, etc.) of said ow3er or owners, and is duly authorized to perform or have performed the said work and to make and file this appllcatmn; that all statements contained m this apphcat~on are true to ~he best of his knowledge and belief; and that the worl~swornWill,to before~be performedme thisin the mannerl set forth in the application filedtherewith.~,~._~//~,ith. "~ ........................ day o,f .... ~ ....... , 19 .q. Notary Public .... / w,- ,)~,~ .¢-~,~~... \ ...... County " t~ry P,t)llc, ~te of .aw f, rk ./// ,A/g r~rc'/ / (~,nt) Torm F. xplr~, March 30,