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Home My WebLink About11527-z FOF,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11527 Z Permission is hereby granted to: ....... . .~~...~..~.G..~...~....~..~z' ....... ,~.×...,~..~..~.... ....................................... ....... ~,~.,~.~,~...~...../z ~e~ ~o ....... .~..~.~..~-~.z'.~./ez......o..~.......,.. .................................................. · . . ~ :~// ~ · .......................................... ~ ............................... .~.;~ .~.~.¢, .',~.~.,~,~, at prem ses ocated at ./....,~./~.....0.. .... Z..~.~/,~.~.~...~...~..~..,.. ....................................... .......................................................................................................... .c:.~,~...,:.Y..:. ......... County Tax Map No. lO00 'Section ,...~...~.,~. ...... Block ....~...~. .......... Lot No..~.~,. ........... pursuant to application dat:d .--~.~.........~...C~..:. ........ (. .............................. , 1~..~.., and approved by the Building Inspector. FIELD I~SFE~ION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY C~DE FINAL COMMENTS ADDITIONAL COMMENTS: FORMNO. 1 t- ACO,E ~'~,~ ~o~%'-~.,-- ~r. ~ ~d TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 7651803 Pc,mit Disapproved a/c ......... %..; '. ....................... ¢ · APPLICATION FOR BUILDING PERMIT Application No..//.t(...~.~.~.. ....... Date 1'2-// .., 1~.,.. 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, tiousing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. / .... .-Z'/.~.~..'7~-.... y~ .c..~.T'...~.c. ~.~ .......... (Signature of applicant, or name, if a corporation) ~ ... ~.~.~...~.~.~...6: .~. w..~..v.~.qw, i ~,.Y.~. ~..~.'t (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....?.~...~. ? ?f. ~...~..~...~..~Z~....~ .~..a:. ~.~ ~ ............................... (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 .......................... Electrician's License No. '~ ~J/~ I-'~/:~ ~t~tgx Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number x~ / ti/F) Street K County Tax Map No. 1000 Section ~...~..~.(q;.' .......... Block .~....~../..:.. ..... Lot .x~.. ~/. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~ ¢P~.'~T/ ....~ .l~..~. 3..¥. ~ .................................... b. Intended use and occupancy ..... .~...~'.~..~..-? .... .~'..~.~.~.~.'- .... .~...~--...~-. ! .~....~r-~... ~..~.O../././~ .~. ...... 3. Nature of work (check which applicable): New Building .......... Addition.. ~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... : i e.r~.5°s/z~~ (Description) 4. Estimated Cost ...... .~o e:~ ~ .~..O .................... Fe ..................................... (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 mixed occupancy, specify nature and extent of each type of use .wi..~'..~'...W~'. · .~..~.~.~ .o.~.t~-~ 7. Dimensions of existing structure~, if any: Front .....'~.. ........ Rear ...."~.~. ....... Depth . .?~..?. ........ Height, ...[~...~..w7 ..... Number of Stories ........ [ .................................. ~4'~ .......... Dimanlions of same structure wi~h alterations or additions: Front ..... .~ O. ........ Rear .................. Depth ~ ~. .. ~.. Height ... I .% Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... ~. [l~c..! ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ! .................. Name of Former Owner ............................. 11.. Zone o3 use district in which premises are situated ..... .~..~.$.~ .~ff...~-'-'f~...~ .................................. 12. Does proposed construction violhte any zoning law, ordinance or regulation: ..... ~ .O. ...................... 13. Will lot! be regraded ........ I~..~. ................ Will excess fill be removed from premises: Yes Name of Architect ........ I~. !1 .t% ............ Address '0;¢'D;h .................... 2~.'3 354 )~ Nmne of Contractor ......... ' ~..~'~. ~. .......... Address ................. ~. Phone No. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. ~ STATE OF NEW,,YO, LR, K, . COUNTY OF. ,~b.[..~..'[ [~. ..... .... ~.. ~ & ~ ~ ~.. ... 0 ( ~ .................... being duly sworn, deposes and says that he is the applicant ~ (Name of individflal sign ng contract) above named. C.o roFo. . ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dui authorized to perform or have perfomed the said work and to m~e and file this app~cafion;:that ail statements centred ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne~ set forth in the application filed therewith. Sworn to before me this ..... ~/.~ .... ~ ...... day o~..~~ .... 19 NOTARY PUBLIC, State iOf New York . ~. ~.4 ~K .... ( ...... of applic~t) ~ommh*lon Expire* garch