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Home My WebLink About11199-zPerr~ission: is hereby granted ~(THIS PERM:l* MUST BE KEPT ~i'q:i COMPLETION Oi: THE WORK AUTHORIZED)} at p~emise$ located at Co~ty TC~X Map No. 1000 !Section;)~./....~{Z?.....;;:.Z~-. BI~E pursbant to apphcahon dated ........ ~.......,... ~:..~ ..... Bml~lng I~spector. , ~ and ~pproved by the FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ApproveddJ.,e:.. .... l ..,'ermit No.. Disapproved a/c ........................... ~. ......... (B~td~t(g Inspector) Application No.. [/../..~7. ..... APPLICATION FOR BUILDING PERMIT Date "~'~" I 19~Y/ INSTRUCTIONS a. This application must be completely filled 4n 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 premises 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 apl: 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 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 HEREBY MADE to the Buildh~g 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 buildiogs for necessary inspections. .... ~--~'. ~>T' "T'~3'~ - - ~ ...... ~3~" ' ~" ................. p !Signature of applicant, or name, if a corporation) C~ ,~7'c /~c,~. ~M~iling a~d~ress of applicant). //7 ..... 5 t~ ~. ~ . L,' ~ ~,.. cT v ~ :~ .- 5 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiI& Name of owner of premises ,.. :... ..................... ' ............. (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..,A~.~. -~. ............. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ....... .~...~..~...).~W~z...e .t~..~.&.~.~.m ................. ...... ............... .............. ........ Hamlet ~ House Number Street ty T ~,0~ ~../,ff Lot..F_~./'.~.. Coun aX Map No. 1000 Section ................. Block ... ........................ 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 J~.'~.'J~..~r'?=.&..~. b. Intended use and occupancy ............... .......... .... · .................................... 3. Nature of work (check which applicable): New Building .......... Addition. , ........ Alteration_ .......... Repair .............. Re oval .... ~ ........ '.. Demolition. ..... ~...... Other Work.. ~- -c ,x~c , ~ (Description) 1. Estimated Cost ..................................... Fee .................. ~. ........... (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 : ' 5. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... 7~ .............. 7. Dimensions of existing structures, if any: Front ............... Rear ....... ....... Depth ............... Height Number of Stories i Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Nmnber o~ Stories ...................... ' Depth ....... 3. Dimensions of entire new construction: Front ............... Rear ....... ~ ............... Height ............... Number of Stories ........................... , ............................ Z Size of lot: Front ...................... Rear ........ :Depth ...................... of Purchase Name of Former Owner ' ). Date ............................. ~ ............................ I Zone or use district in which premises are situated ~. Does proposed construction violate any zoning law ordinance or regulation: ; .~. ?. t. Will lot be regraded ................ ./'f..~. ........Will excess fill be removed from premises: Yes ~. Name of Owner of premises ............... ..... Address .............. i ....Phone No ................ Name of Architect ........................... Address .............. ~ .. Phone No ................ Nmne of Contractor Address ' Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from coperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~.terior or corner lot. 'FATE OF NEW ~5'ORK. ..... ~1' sigfli'ng contract) ' bore named. ...... being duly sworn, deposes and says that he is the applicant e is the ............. ~ ................................. , ............................. (Contractor, agent, corporate officer, etc.) ~' said owner or owners, and is duly authorized to perform or have performed the~said work and to make and file this pplication; that all statements contained in this application are true to the best of l is ~mwledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this Plo. 52.8125850, Suffolk Coun~. Term Expires March :30, 19.~