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Home My WebLink About11015-z Fo~ N0. ~ BUILDING DEP/ARTM ToWN HALL SOUTH'OLD; N~ Y, BUILDING PERMr (THIS PERMIT MUST BE KEPT ON TI~.E P~Ej^I~ES UNTIL,FULL COMPLETION OF 'THE WORK AUTHORIZED) ; Building I~spector. F~, ;..,,..~..!; ........... Inspector hereby granted to: : ,..,- ; .v/ ? . ~:z~ ,...~.g.~.~:...: ...... ::.,~...2 ................ ,o .. ~~ ........... ~...:..~.....:~¢~...~. ~..~~...~*,-*~ .......... ~ , _ ~~. ~~ ~ ...... ,; ................... ...... ~ .............................................................. :....~ ........... ~ ......... ~,.,~ .. ... ~ · ..... couh~ *~x ~,p uo. moo ~t~o~ ...~.G'..~.....L. e~ :.~.J~ ........... u~ Uo..~.o.~.~..t ..... pursuant to ~ppllcatlon d~tod .... ~, ........ , 19 ~ ond opproved by the FI~uD-Y~SPECTION FOUNDATION (Ist) COMMENTS FOUNDATION (2nd) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY COQE FINAL ADDITIONAL COMMENTS: Examined ~.~.O..'. f.d..., FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ Application No../.[~.[.. ~'. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT · 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...... ,~..Eo.~....~..q.o.: ............... (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 builder. e~ ~..~x~-~, ~ .............................................. Name. of owner of premises . .'~¢.o4~...'~lGt.~.~)i~ ...................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...... %1: ..................... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No..~.../.6.~. .............. I. Location of land on which proposed work will be done .................................................. ® House Number Street ~4 Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed co~astruction: ..... ~.~.~. 7. o~,~ ~ . . ' a. Existing use and occupancy .... ................................ b. Intended use and occupancy ..... ~..~.~. :...~ ~.m..~ 3 .~. ~.. [{ .~..-..-~_. .......... 3. Nature of work (check which appligable): New Building .......... Addition ..; ....... Alterat~n ........... Repair .............. Remove! .............. Demolition .............. Other Work .~.~..~.~.~.W~ .... ' (Description) 4. EstimatedCost... ff /'700. ¢~,) . Fee ...................................... i (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 o,'ccUpancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Numbe, r of Stories ................................... ~ .................... Dimensions of same structure w~thl alterations or add,teens: Front ................. Rear .................. Depth ...... ': '. .............. i Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Hei~ght ............... Nujnbgr of Stories ............ ., ......................................... Size of lot: Front ..... .f~.q ... i~ ......... Rear ... g,,~.o. ............... 'Depth ...~p.o..~ ......... i ..... Date of. P~urchase ............ i ................ Name of Former Owner ............................. Zone or USe district in which prem'ises are situated ............................................ ~, ........ Does proposed construction violet? any zoning law, ordinance or regulation: ....................... :~ ........ Will lot be regraded .......... ; ................. Will excess fill be removed from premises: Yes No Name of Owner of premises ~..m~.~..'~..lo~. \g i-.2... Address~,.l[~.~'r.~.a ~V .~: ~ .... Phone No..~.~- L~oJ~ Name of Architect ~ Address ........... .~ ....... Phone No ..... Name of Contractor Address Phone No 10. '11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, 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...YORK, ,~ ~ ........... .~..: .~-~ .~4~..c~ ~ 0.~,' ............... being duly sworn, deposes and says that he is the applicant (Name of individual si~ing contract) above named. He is the ......... ~ .... ~ ................... ~ (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is du~y authorized to perform or have perfomed the said work and to m~e and file ~is apphcatmn that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this . Qualified iii Suffo~ COU~ I (S~gnature of apphc~t) gommis~i0n ~xpires March 30, 108~