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Home My WebLink About10718-z · 'O'R~ ~{0. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUT~3OR[ZED) No. 10718 7 Permission is hereby granted to' .... z~./.~.L.../..~z_z:kZ~.~.c,. .../~.~,a ~0 ..... o.C.~ ......... ~ ~0.~.~ ........ 0~ ...... ..L.~.o.~ ................................................................................................................................ ~ ~m~, ~o~o~ o~..Z~Z~....Z~.~.~..~.~..~ ..................................... ....................... ~r~.~.~.~.... pursuont to oppllcotlon doted ........ ~.~ ................... ~ 19 ........ , ond opproved by the Buildin~ Inspector. FIELD INSPECTION !. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL COIv~I~NT~ ADDITIONAL COMMENTS: TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved dCd~.~. ....... /..~.. ............. , 19 . Permit No ........... Disapproved a/c ................... -~. ......... ~; ................................. / ........................... .... .~--..~ ,~-,,.-,,,, .;;,..,..,,, ... .............................................. ~'"'7'-'~ ~'l~'~ ddlng Inspector) APPLICATION FOR BUILDING PERMIT Date ..J~..../...~....ZZ. .............. , 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 set~ 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 application. 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 Buddmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 applk;ant, or name, if a corporation)~,/ (Address of applii:ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........ ........ .: .......... .......................................................................................................................................... Name of owner of premises .~. \ C6 \-\ ~q ~ ( -~( , bO ~q ~ ~ L ~ ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Electrician's License No ...... Other Trade's License No ............................................... ~1 ,--. __ Location of land on which proposed work will be done. Mop No.: ..... l~.......J~..l..~..I.. ........... Lot No ........................ ,~ ~- L_L- ~D ~;a uc~tCa c ......................... Street and Number .1.~.} ........ .~..~...~.J ............... ..~.~ ................................... ~.. .......................... SOUT~- £~rsv Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ~ 6 ~/~ ~ - /. F-/~ i zL ~ ~ bO L(~ ............................. b. Intended use and occupancy ........................................................................................................ .,/.;.: ....: .. /0o o -- $. Nature o{ work (che¢l< which~appllcable). New ~;t~J~ng ............ ~ ............ Repair .................. Removal, .................. Demolit.on ................Other Work .~,~.?.~.....~.~9.~.~. ...... / (Description) 4. Estimated Cost ~ ~o I ~ ..................... , ...................................... Fee ...................................................................................... (to be paid 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, commercial or m~xed occupancy, 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 Stones ................................ 8. Dimensions of entire new co~struchon: Front .................................... Rear ............................ Depth ....................... Height .................... Numbe~ of Stories ................................................................................................................ 9. Smze of lot: Front .... ~.~b.'.,~ .................................. Rear ...... ~.~.~.:..~ ................... Depth ....... ~.~..O ............. 10. Date of Purchase ................. I .............. ~ ....................... N me of Former Owner ..~.~.~.~,~.~.~ ....... ~.~.~.~.~ .... 1 1. Zone or use district in whichlprem~ses are situated ........... ~ ...~...~ .................... 12 Does proposed construchon v~olate any zoning law, ordinance or regulation: ..... ~.~ ............................................ 13. Wdl lot be regraded .,..~ ........ l .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premise~l~HB.~.~....~:...~.~.~.~,~ ....... Address ~.(b.~.....~.~.... Phon~ No. Name of Architect ....................................................... Address ................................ Phone No.., ................... Nome of Contractor ........... ' ...................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether exisnng or proposed, and indicate all set-back dimensions from property lines Gwe street and bbck number or description according to deed, and show street names and indicate whether interior or co~ner STATE OF NEW. YI~i_<,.//./~ -'"~VName of individoal'si above named. S,S .... ~~f..~ .being duly sworn, deposes and says that he is the ,appliconl ning con rac ) He ~s the'. ............................ ~ ................................................................................................................. (Contractor, agent, corporate officer, afc ) of said owner or owners, and is dply authorized to perform or hove performed the said work and to make and file this application; that all stotemerlts contained in this application are true to the best of his knowledge and belief; and that' the Work wi[I be performed in 'the manner set forth in the application filed therewith. Sworn to re me this