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Home My WebLink About11427-z FOIl. BI NO. ~ TOWN OF S:O~ITHOL'~ TOWH HALL SOUTH'OLD, H~ Y. BUILDING PER~IT' (THIS PERMIT MUST BE KEPT ON TH, PI~.E/~IS S UNTIL COMPLETION OF THE WORK AUTHORIZED) N? 11427 Z ULL Permission is hereby granted to: ~ .......... ~.~.~ ....... .... ~.0...:.....~ ......... ..... '~ ,o ........ ~.q. ~...~.....~...~.~.... ~..~../..~ ~. c....... ~.. ~.. ! ~.~.~. ~. ~..~....w..~.~., ................... ,, ~,~,,,, ,o,o,,~ o, ...~...~..~i ~....~ ......... .~~9~.~./...~.:7. , //0 i,'~ ' i .~....,~.. ........... CoUhty TaXx Mop No. 1000 Section .../..~ .............. :. Block ...~..tK.. ....... :~Lot No. BuiJ~lng I~spector. Rev 6/30(80 Building FIELD IN~ECTION 1. FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, ELY. 11971 ~;) TEL.: 765-1802 Examined~...~..?~. '.' ..... , 1 .~. Approved(~..7-7..Ze:... .... ,,~../permitSo../../..K-.?..7-~7 .77 .................. ' _--- __ -[~r,- ' ' . 1 '~'/~"t, /: (Building Inspector) =z'/2d>~'9: ~z~ ~,,,~ ^PmC,~T~ON FOR ~U~La~n~ INSTRUCTIONS Application No. '/'/' '~'~f'7 ...... 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 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 promises or public stre( or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this aPF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc','al 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 tbronghont 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 Bui/ding Inspector· APPLICATION IS HEREBY 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 Regulations, for the construction 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 premises and in buildings for necessary inspections. (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 bnild, Name of owner of premises . .ff.~. ~. M .~..'~...~. ~/~//~. · . . ./.~.C ' . ........... , ......... (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. ~/~ .~Z.~ ~ Plumber's License No. " Electrician's License No ....................... Other Trade s Li,ense No. · 1. Location of land on which proposed work will be done ..... . .~'...~.,~... ~.~.~.....'-~-.....~ .f.~/~..c~.~.~. ~ .~.~. ..... .............................................................................. House Number Street Hamlet County Tax Map No. 1000 Section ... / /c) Block .~ ~'. Lot Subdivision ~ Filed Map No Lot (Name) 2. State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.,~O. ~..X'.zO....~. ......................................... b. Intended use and occupancy ....~.,~"~...~./.~.~;~'.... ~-/~.. f./.~., '--~-.,f~C~~.~..... Natureof work (check which applicable) Repair .............. Removal ... Estimated Cost ....... ' ........ {. If dwelling, number of dwelling Units .. Dimensions of existing structure~, if any: Height ............... Number of St Dimensions of same structure wi~h altera' Depth ...................... Heigh Dimensions of entire new construction: l- Height: ............... Number of St New Building .......... Addition .......... Alteration .......... ......... Demolition .............. Other Work ............... (Description) ................. Fee ................... , ......... (to be paid on filing this application) , .......... Number of dwelling units on each floor...; .......... If garage, number of cars ...................................................................... ., If business, commercial or mixed occupa :cy, specify noture and extent of each type of use ............... Front ..... .' ......... Rear .............. Depth ............. ~ries ................ ' ...................................... ions or additions: Front ......... i ....... Rear ................ : ...................... Number of Stories .................... rent ............ Rear .............. Depth .......... ~ries ........................................................ ). Size of lot: Fron~ ........... :'. ....... I .....Rear ............... ' ........ Depth ...................... ). Date 6fPurchase .................. I. i ...... ;.. Name of Former Owner . i ' i ......................... 1. Zone or use district in which premises are situated.., i ..................... '. ................. 2. Does proposed construction violate any z ~ning law, ordinance or regulation: ................................ ~. Will lot be regraded ............................. Will excess fill be removed from premises: Yes No L Name of Owner of premises .... ............. ..... Address ................... Phone No. 7fi.~....~ .o.~[ ..... Name of Archifect .......... . ................. Address ................... Phone No ................ Name of Contractor. Locate clearly and distinctly all buildinl roperty lines. Give street and block number terior or corner lot. ......... Address ................... Phone No ................ PLOT DIAGRAM whether existing or proposed, and, indicate all set-back dimensions from description according to deed,' and show street names and indicate whether I'ATE OF ~E~~ OUNTY OF .).~. 7'~' ...... ,S'S (Name of indiv dual s g d ~g cont~ >eve named. e is the ...................... : ....... f said owner or owners, and is dul:y autho~ ~plication; that all statements contained in 'ork will be performed in the manne'r set fort worn to before me thij' JUDITH T. TERRY ~ Notary Public, State of New Yore / /{9, 52-0344963 Suffolk Cpuntyff'~ ~olnml*~ort Expires March 30~ ............. being duly sworn, deposes and says that he is the applicant act) Contractor, agent, corporate officer, etc.) [zed to perform or have performed the said work and to make and file this ;his application are true to the best of his knowledge and belief; and that the a in the application filed therewith.