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Home My WebLink About11220-zFOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: Perr~is (THIS PEP, MIT MUST BE KEPT ON COMPLETION OF THE WORI~ AOTI~I~I:zED~ iii 2 2 0 Z ~ot~ af,p~emises located COUfit~ To~ Map No. 1000 ;}ection p~p~ant application ;dated ; ....... : B~ii~ing I~spector. * '~ .~ ~.,-0~0 No.~./..~,... ~. ..... ahd ~pproved by th* FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 , /~ TEL.: 765-1803 ~,,a,nine~. ~-~' '~..U 5..~...,~ F/ DisapprdEed ~PPLI~ATION FOR BOI~DIN~ PERMIT Application No ,//~ INSTRUCTIONS 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 premises or public strec 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 approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such per~ 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 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 describ~ 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 in~spections. .......d__,¥-, ..... (Signature of applicant, or name, if a corporation) · . (Marling addle'ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build (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 ......................... [ Electrlcmn s License No ..................... Other Trade s Lmense No ..................... 1. Location of land on which propgsed work will be done ............ . ................................... ~.~ . >. ~. . . . /.,.~. .~,~ ./,~ ,~ ........................... , ........ House Number Street County Tax Map No. 1000 Section ./.~..~. ........... Block .... ~ ............ Lot. ]..~/..~.~...~.. Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~cupancy ~f p`r~p~sed c~nstructi~n: b. Intended use and occupancya. Existing use and occupancy . .~~::~ ~~~{~~ ~- ~--~~.~ ...... q ........... 3. Nature of work (check whicb applicable): New Building .......... Addition .. teration ......... pat Re r .............. Removal ............ Demolition i Other Work.. ~ ' , ' (Description) 4. Estimated Cost ............................... Fee .,, ~ ............ .r .......... (to beipaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............. If garage, number of ears 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. r' ' ' ' 7. Dimensions of e,xisting structures, if any: Front ....,..~ ........ Rear ...8. :i ....... Depth ... ~/.~. ..... Height .. ~/ff. .......... Number of Stories ...................... ] .... ; ................... l" ..... Dnnensions of san}e strncture with alterations or add~tlpns: Front . [.~. ...... ~ ..... Rear ... ,/..~. ........ Depth ..... ~ ff. .............. Height ...... /...~' ..............Number of Stories ................... 8 Dimensions of entire new construction: Front Rear : Depth Height ............... Number of Stories ....................................................... Size of lot: Front ... [. {.~7~ ..~. J. ........Rear...~..l oC'l,~ .~ff.~. ...... i Depth ... o~.~N"~... Date of Purchase ./..~ ~.. ¥. ................... Name,~ of Former Owner ~'f.-~r~..~"2~.~/,~ ........ Zone or use district in which premises are situated ..... ,~....~...s'3fl~. ..... , ............................ Does proposed construction violate any zoning law, ordinance or regulation ...'~2 ~. ....................... Will lot be regraded .......^.--7..~. ........ /....~11 excess fill be remov, ed from premises: Yes N Name of Owner of premlses(-~,4ev'~.'~/~o-rz .7~v'~Z~sddress .~..~. ~..e~e~.... Phone No.~. fl~'~.-.~. Y. 2./. Name of Architect Address ~ Phone No Name of Contractor Address ~ Phone No 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and dmtlnctly ,all buildings, whether existing or proposed, and, ~dlcate all set-back dtmenslons fro property lines. Give street and block number or description according to deed, and show street names and indicate whetht interior or corner lot. / STATE OF NEW]YORK,-- . ~ ~ COUntY OF ..... .~ ....~'~ ........................................... being duly sworn, de ?oses and says that he is the applica: (Name of individual signing contract) above named. He is the ~ ' (Contractor, agent, corporate officer etC.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl~ application; that all statements contained in this application are true to the best of his knowledge and belief; and that tt work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ./{:~ ~.'...daypf.. ~ ....... , 197/~. Notary Public, . ........................... County (Sig~nature p app man