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Home My WebLink About11365-z TOWN OF~ ~ BUILDING TOWN iHALL · ' SOUTHOLD, N~Y. i BUILDING p,ER~I~ (THIS PERMIT, MUST BE KEPT ON THE PI~E/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AuTHORizED) Ns ~3~s z ~,~ ..,....?......, ~,..~ Permissio~ is hereby granted to: ~ . .~.~ .~Z . ..~. ,. ~..~.. ~~, ...... .... ~~x ............ ~'~"'Z"'? ................ ~o ;.- ................................~'"':' ............... at prem ses ocated at .~ ......... ' ' ~ ~ B ac Mop No. 1000 Sect,on ....... '~ ......... ~, ~.. ~.'. 5L · .................... B~il~ing Ipspector. : CTION "DATE COMMENTS (1st) (~nd) ~UMBING ~NERGY ADDITIONAL COMMENTS: FIELD FOUNDATION FOUNDATION 2. ROUGH FRAME $. INSULATION STATE CODE 4. FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .SOUTHOLD, N.Y, 11971 TEL.: 765-180:2 Examined .-.~..~..'~....~. .... , 19.o/57./. Approved "~F' '~' ..... 19.~f. Permit No. (Buikling Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No(../.-.~.~,~7 ....... Date .............. , 1 a. This application must be completely filled in by typewriter or in ink and submitted iu triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according te schedule. b. Pie, plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this apg cation. c. The work covered by this application ,nay not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issne a Buikiing Permit to the applicant. Such pern 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances admit authorized inspectors on premises and in buildings for e~ ~~. /~./_~'i (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ................................................................................. Nmnc of owner of premise ............ ! ......... ' .... [ .............. (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 ........ ~ .......... Pltuuber's License No ......................... Electrician's License No ....................... Other Frade s L .c ~se No. Location of land on which proposed work will be done ................................................ ,~;use Nu,nl;e, ' Street Hamlet '3',~ ;~/ ...... County Tax Map No. I000 SectionOo~.,~0.0 ......... BlockO.!,..0..O. .......... Lot .(~...3.,.0.~../. ...... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use a~d occupancy of premises and i~euded use and occupancy of proposed construction: a. Existing use and occupancy./~.~/.~....~...~./~ ..... ~ .~ ./ .................... b. Intended use and occupancy .~. .......................................................... 3. Nature of work (crock wind appbcable, Repair .............. Removal ... Estimated Cost. =aQ~.. ............ ). I. 2. }. qew Building .......... Addition .......... A1 t c ra~' o~n~ itl t.:._ ~' ...... Demolition t:~ .......... Other Work~.9~.-. ...... (Description) ....... Fee ........................ -~ ........... (to be paid on filing this application) ;. If dwelling, number of dwelling units ............... Nmnber of d;velling units on edgh floor. :; .............. If garage, number of cars .................. ~¢ ................................ ., ......: ............. L If business, conlmercial or mixed occupancy, spe,9~9~ttsre and extent o f~a/~t't/t2)pe of use ...... ..~ ~.t~ t, ...... ~. Dimensions of~J<isting structures, if any: Fronto~d~.~. .... ,. ~.. Rear ,¢~ .c~. ........ Depth ~,.~ o .c~: ....... Height ..ff.'Z// ......... NumberofSories...] ...................... :...~- ........................ D mens OhS of same structure with altera lions or additions: Front ................. Rear .................. Depth ...................... Iteigl t ...................... Number of Stories ..................... L Dimensions of ehtirc new construction:z'ront .... 4; ~ ........ Rear ............... Depth .............. Height ........... >.,,.~.. Number of Size oflot: Front .~.O .............. [ .... Rear .~,t~?/.~. ....... ' ....... Depth /. Z~".r.~.,.~ ............. Date df Purchase ................. ' ~ ........... Name of Former O~vner ............................. Zone or use district in which premises a ~ situated ~.' ..... ~ ~7.[...' .................. Does proposed construction violate any; oning law, ordinance or regulation: .......................... Will lot be regraded ........................ Will excess fill be removed from premises: Yes Name of Owner of premises .................. Address ................... Phone No ................ Name of Arch/leer ........................ '.. Address ................... Phone No ................ Name of Contractor Address Phone No Locate clearly and distinctly all. buildin roperty lines. Give street and block numbe terior or corner lot. PLOT DIAGRAM s, whether existing or proposed, and. indicate all set-back dimensions from n' description according to deed, and show street names and indicate whetI~er f said owaer or owners, and is drily autho ~plication; that all statements contained in 'ork will be performed in the manner set for worn to before me this ,,,..gl : ....................... da of. .5q,5 6, TATE OF NEW YG.R.K,. / OUNTY OF. ,~..tt 9"~ I.E.... s.s .............................................. being dtdy sworn, deposes and says fltat he is the applicant (Name of individual sig~ling cont 'act) >ove named. e is the ............................ ,, ............................................................. ]Contractor, agent, corporate officer, etc.) ized to perform or have' performed the said work and to make and file this this application are true to the best of his knowledge and belief; and that the in the application filed therewith. otary Public ,,. ' (Signature of applicant)