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Home My WebLink About11259-z Foit~[ NO. ~ TOWN OF SOUTHOL TOWN HALL SOUTHOLD, Nm Y. BUILDING P,ER~IT (THIS PERMIT MuST BE KEPT ON THE PRE/V~ISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: .............................................. .................................. ~ .............................. / ~-"-~' l~ : ~ ......... - ~ ............. ~.m~....~ ~..~..~T~... ~...~.~ o~ premisos Iocotod ot ...... ~..0..~..~.~ ............ ~ ~ J~.l..~.... .~......~. ...................................... ................................................................................................. Co~ ,o~ ~op ~o. ~0oo ~s,~o~ ..... [.~:~ ...... mo~k~ .~ { ).~ ....... lot ~o....(~.~.~ ...... pursuant to application dated ........ Baildlng Inspector. ;,...., 19.~.l and approved by the Building inspector Rev. 6/30/80 FIELD I~PE~ION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY q,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined &J£/(':f ....... , 19d.'L Approved t{. 7 {,~. 190'./. Permit No. D sapproved a/c · . . :..'~-7.~'T. . . q ................................... ~dZ ' ~: :~' '~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. INSTRUCTIONS a. TMs application must be completely filled in by typewriter or fn 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 qmwing 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 apr. 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 avadable for inspection throughout the work. e. No braiding shall be occupied or nsed m whole or ~n part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance ora 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, amd admit authorized ~nspectors on premises and in buildings for necessal~ inspections. (Signature of applicant, or n~me, if a corporation) .... I~_..4..g.,..~o.~.% L ~.}. g .......... (Mailing address of applicant) Stat?'hwhether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ...................................................... Name of owner of premises .~.~_,~:-..~...J~.ii~k,~.O. ........................................ (as on the tax roll or latest deed) If app~~ure of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ,~. .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work w,ll he done...f?4.~...4. ~. [ 6o~ ~ ~,O .... :. ,....~...Z..r..C ............. g<q.~..~. ~.% ............... ~ .o.O}...~: .~..~ ................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ! ............. Block .... .(3 '~ Lot. Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of pre~nises and intended usc and occupancy of proposed construction: a. Existing use and occupancy .~l~9'~e-~ L- ed use and occupancy ~.../.4.~ b. Intend . ................ .' . ~.~..77... Nature of work (check which applicable): New Budding .......... Additmn .......... Altmatlon .......... Repair .............. Removal ............ Demolition .............. Other Work ............... Estimated Cost ,. .. ..................... Fee .................. -.. ........... (to be paid on filing this application) If dwelling, number of dwelling Units...~ ............ Nmnber of dwelling units on each floor ................ If garage, number of cars ..................................... t ................................... ' ' ' ~ ~*f h typ f H business, commercial or mixed occupancy, specify n~ture and exten o eac e o use .................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Nnm, ber of Stories ....................................................... Dimensions of same structure w~th alterations or additions: Front ................. Rear ................. Depth ...................... Itei~t ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Nmfiber of Stories ....................................................... Size of lot: Front ....................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Fomer Owner ............................. Zone or nsc district in which premises are situated ....... ' .............................................. Does proposed construction violate any zoning law, ordinance or regulation: ............................... * Wit~ lot be regraded ............................ Will excess fill be removed from premises: Yes No Nan~e of Owner of pre~mses ..., ................. Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Nmne of Contractor ........................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly .-dl' buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block 'numberchz.d..escr/ption according to deed, and show street names and indicate whether tenororcorncrlot. ~.,~ ': ' ~~5'5 ~~ TATE,OF,NEW Y~PA~, -- : OUNTY 0~~ is's (Name of indMdual signing contract) >ore named. being duly sworn, deposes and says that he is the applicant e is the ..................... ~ ................................................................... ! (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is duly author/zed to perform or have performed the said work and to make and file this ~plication; that all statements con[ained in this applicahon are true to ~:he best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed d~erewitb. worn to before me this.. £- dayo£ 19 .................. ' r,;m ~1,,, ~,reh a0k ,~- d/ d (Signature of applicant)