HomeMy WebLinkAbout11412-z FOItM NO. ~: '
TOWN:OF SOUTitl0L~D ~i
BUILDING Di~pARTMi[NT
TOWN iHALL ?
SOUTH'O[D N Y '~
BUILDING P,E~IT: ¢
(THIS PERMIT MUST BE KEPT ON THE PRE~ISt:S UNTIL ~ULL
COMPLETION OF THE WORK AOTHOR ZED)
N? ~1412 Z rote ..~ ......... , 19.~.../
Per~nissio6 is hereby granted to:
........... ......
.......... ~.,....~~.~:.~....
Z~.~c~.....z~ ..........
~o ..~....~ ............... ~m~.~..,......~ ....... ~....:..,....~;,.~:¢.{~. ....................................
purskont {o application dated .. . and kpproved by the
BuRl lng I specter. :
FIELD INSP~I
FOUNDATION
FOUNDATION
ROUGH FRAME
3.
INSULATION
STATE
CODE
FINAL
iCTIC~ iDATE COMMENTS
(1st)
(2nd)
~UMBING
PER N. Y.
~NERGY
ADDITIONAL COMMENTS:
,~ , FORM NO. 1
TOWN OF SOtJTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examine~..~..~]...~. ..... ,19~.../.
Approved~..~ ....... 1~. Pernlit No..~ff ........
Disapproved a/c ....... ; ..........~j'....~ ....... ~..'. /
(Building Inspector)
APPLICATION FOB BtjILDING PEBMIT
INSTRUCTIONS
Application No. t~./..~../..~. ......
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi
Inspector, with 3 sets of phms, accurate plot plan to scale. Fee accordiug to schedule.
b. Plot plan showing Iocation of lot and of buildings on premises, relationsh_;p to adjoining premises or public stre¢
or areas, and giving a detailed descriptiou of layout of property must be drawn ou the diagram which is part of this apl;
cation.
c. The work covered by this application may uot be commenced before issuance of Building Pem~it.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern
shall be kept on the premises available for inspection throughout the work.
e. No buihling 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 1S HEREBY MADE to the Building Department for the issuance of a Building Penuit pursuant to t
Building Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the constnmtion of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premiscs and in buildings for necessary~spections. ~ - '
.... . ..........
~ *' ~ ~ ~' (Signature,~f appticar~, or name, if a corporation)
Sx~)~whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build,
o, o, ....................................
(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.' ......................
Other Trade's License No ......................
Locatmn of land on which proposed work,~ill be done... ~.~....-~.......~..~.....~...~.'.~.-fi:/~'7~ .--7-. ....
...... .............. .......... ....
House Number Street Hamlet
County Tax Map No. ~00O Section ..[..~/ ......... .... Block O~-- Lot.?.?.~.'
Subdivision Filed Map No ' Lot
(Name)
State existing use and occupancy of prefil)fises and intender4 use and occupancy of proposed construction:
a. Existing use and occupancy ...~'-~...~...~.~ ~....~7:7..'. ....................................
b. Intended use and occupancy
L Nature of work (check which applicablel New Building .......... Addition .......... Alt '
er t~.._'~ ........
............... Wor~ .......
Repair .. RemOval .......... D~,mohtmn .............. Other
, : ,~ (Description)
' Estimated Cost .... .~.'.~...~.. ........................ Fee .... ./.~.~7'-..~' ............... , .........
, (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
i. If business, commercial or mixed occup~ ~cy, specify natnre'afid extent of each type of use .....................
L Dimensions of existing structures, if any Front .... ' Rear .............. Depth ...............
Height ............... Number of S eries ........................................................
Dimensions of same structure with alter~ ions or'additions: Front .................. Rear ..................
Depth ...................... Heig] t ...................... Number of Stories ......................
~ Dimensions of entire new construction: rent Rear Depth
Height ............... Nun~ber of S ;odes ........................................................
. ). Size of lot: Front ............ ·.. '..., ..... Rear ...................... Depth ......................
). Date df Purchase .............................. Nsme of Former Owner .............................
I. Zone or use district in which premises ar, s~tuated ........................ ".
2. Does proposed construction violate any ::oning law, ordinance or regulation:
~. Will lot be regraded ..... 7:--'7" ..... ~52~3 ...~9~.[L4,. Will excess fill be removed from premises: Yes No
1' NameName of Architect°f Owner of premises-~./~'/~z.x~. ~.Address ................... Phone No ................
~-" :~' ~.... Address ................... Phone No..~.~..ff.:~..~...%.
~5~7-. -.~~. ,~..'.. Address ................... Phone No ................
Name
of
Contractor
PLOT DIAGRAM
Locate clearly and distinctly aliI bnilclin~;s, whether existing or proposed, and, indicate all set-back dimensions fi'om
roperty lines. Give street and blockinumber ~r description according to deed, and show street names and indicate whether
~terior or corner lot.
TATt':A) F NEW..,~ ,RI4/, .~ :,. ,.
onlx/~ OF~~" ' ~~~~. · · · ·ia:?' being duly sworn, deposes and says that he is the applicant
(Na e of ndi tdual sign
lng contl act)
2eve named.
e is' the...
Contractor, .agent, corporate officer, etc.)
t' said owner or owners, rind is dulY autho ized to perform or have performed the said work and to make and file this
)plication; t~l~at all statements contained in :his application are true to the best of his knowledge and belief; and that the
'ork will be pe/'formed in the manner set fort ~ h~ the application filed therewith.
worn to before me this
~ ........ ~...ff~....day of .~f" i~-~.., 1 ~.'./
tary Publlc, ............... .,,~4~ ~ ~,. 4~County ! ~
New YOrk "'-"~"~" ..... - .... ~ ~' 't' ~ ....................
II0. S- Count~.~' ' (J ~' (Signature of applicant)
Term Expires March 30