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Home My WebLink About11204-zNo. [12fl4 7 Permissidn is hereby granted to: (TH S PERMIT MUST BE KEPT ON' CTFIE PR~I~ES:UNTIL FULL COMPLETION OF THE WORK ,~.UTHDRIZED)~ ~ .~ote ~....q ............. ~ .............. , ...... at premises located at County Tbx Mop No. 1000r Section ...... . .~ .. BI~ ~Ur~nt :to opplic~tion~ doted . Building Inspector. Lot No ....... ~..~...~ ....... and approved by the FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE (?st) FINAL ADDITIONAL COMMENTS: (2nd) "' "~' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1803 Approv ,~,~. '¢~.~.~(':..., 19~.~. Permit No..~./.C~/.~. ~.~.~ ~ DisapprdOed a/c ............ 7~7 .~...~ ................ ../ ....................~ ,,.-..... .................. ..,._~./ //~_ ~ ~.. / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date !S ...... 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 6f 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. · ~i' .11~, ~'...7. o.~: ~t., .~.~... ~: ............ (Signature of applicant, or name, if a corporation) · ?...~. :'~.~. ~.. ,..~3~. i'.~....~-. Y.. u.q~. a.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .~:%r~%: .......................................................................... Name of owner of premises . ~.~O,r~...~0.¢.~ ......... .~?.~?.-~f..~'5~..c~..~ .~:.. ~..T..6f~ ..................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......... .. ~ ~ .................... (Name and title of co,orate officer) Builder's License No ..... /~ ................. Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .../.Y..-5'.....%..~ooo..~-.. :b .,a.,~ .......... %~%~.¢: ......... , ............................ House Number Street Hamlet County Tax Ma0 No. 1000 Section .... 1~.~.~ ........ Block ....'~,. i ..... Lot ................... ll c~ , /U 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 ....... .~. ??77.' C9! .. ~.~ 1 ~ ................................... b. Intended use and occupancy ....... (p.v)g.-:. .~D~ ................ ............................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~n .......... · . Other Work ' Repair .............. Removal ~ ............. Demolition ............. .4[3 . ' '9 .... (Description) 4. Estimated Cost ,:9,00 Fee . ' (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling 9nits on each floor ................ If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... · Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Numl~er of Stories ............. ~ . . ! ....................................... 9. Size of lot: Front ....... /.7.~ ........... Rear ...... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~ ................... Will ex?ss fill be removed from premises: ' Yes No 14. Name of Owner of premises . ~g.~...~.~. g.o~. ....... Address .'.5~. PO.ri..~ff..~.q~y.e~.... Phone No..9.~q77 ./.t,.o.? ..... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ........ ; ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all' buildings, whetfler existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~{)!~J/- SS ---~~~~ 'c' '' ......... being duly sworn, deposes and says that he is the applicant ( .... ga' g a t) above named.. ' .~.. /~ ~- .. He is the ..................... : ......... ~ ............................................ (Contractor, agent, corporate officer, otc.) of said ow~e[.or owners, ~d is duly autho~zed to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this // .......... ~ ,~0/2~;:~;; ~:~u;;Z~ ~ [ / ' (Signature of applic~t)