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Home My WebLink About11325-z FOE~ NO. 2 TOWN .OF SpUTHOLb i BUILDING DEPART~EN~ TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ' N©. 11325 Z Dote Permission is he reby g ranted t°':../~ .z:~...~..-Z~ ~ ~.~. x~,~ ............. ~.g..,g.~ .... ~o at premises Iocoted ot ~ .......... ~~. '..~.)~0 ~ ...... ................................................................................................ ~....;~ ................. , ........... ; ............................ ................................................................................................ :'"'7 ................ ~' ........................................ Building Inspector. ~ - ~ : ............... FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~1802 E×amincd .1.~.?:./~. .... ,1.~?~. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No ..... 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 bnildzngs on premises, relationstfip to adjoining premises or public stref or areas, and giving a detaded description of layout of property must be drawn ou the diagram which is part of this ap~ cation. c. The work covered by this application may uot be commenced before issuance of Building Permit. d. Upon apprc,al of flus application, the Building Inspector will issue a Buildzng Permit to the applicant. Such pern shall be kept on the premises avadable for inspection throughout the work. e. No btnldmg shalI be occnpied or nsed in whole or ~n part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS llEREBY 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 braidings, additions or alterations, or for removal or demolition, as herein describe The appbcant agrees to comply w~th ail applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on p~emises and in buildings for necessary iL~pections. , (Signature of applicant, or nam~,¥it' a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ..f._.,5~,..~.~.~~ ............................ ./~7 [_/~./~.f.__..///?:.7 ..... ~ .... d.?z-~.,.d..~./~':...' .... ': ................................. N~ne of owner of premises ..... C~. .~. ./.A ~ .r! : ...... :; . / ................................... (as on tile tax roll or latest deed) If applicant ~s a corporation, signature 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 ..................... 1. Location of land oil which proposed work will be done ................................................ House Number Street Hamlet cou~t~ Ta× Map No. 1000 S~ction ....~.'./. ~ ......... B~ock .. :...4(' ........... ~ot...¥4/.. ......... Subdivision ..................................... Filed Map No .............. Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................... -/4 / ,';:, .~ ,,...,.~ ~ , :> ,~,.. ..., / ~ : : , . b. Intended use and occupancy ....~ ..~. i. ~ .'... ('.d.;.,:.(.(...c.~.- ......... ,.'-, -. Q...., ........... '.-.--' ......... I. Nature of work (check wliict, applicable): New Bui/ding .......... Addition .......... Alteration .......... Oth W k .~.~.,~.~..¢(.F-~/~ Repair .............. Rem0val' ............ Demolition .............. er or .... ~ Z~ ~: e~( ¢ ~ ~ (Description) ~ Estimated Cost ...¢. .} ..................... Fe ................... , ......... ' (to be paid on filing this application) ~. If dwelling, number of dwelling ¢nits ............... Number of dwelling units on each floor ................ If garage number of cars ' If business, commercial or mixed occupancy, specty nature and extent of each type of use ..................... Dimensions of existing structures,, if any: Front ............... Rear .............. Depth ............... Height ' ' ' ............... Numlber ot Storms ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ' . ..... Rear ...................... Depth ...................... Date df Purchase ' Name of Foyer Owner Zone or use district in which premises are situated.. .................... ..... .....................' . .... construction violhte any zoning law ordinance or regulation: ' Does proposed .......................... Will lot be regraded ......... . ................... Will excess fill be removed from premises: Yes No Name of Owner of prmnises ..................... Address ................... Phone No ................ Name of Architect ~ Address Phone No Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly ,and distinctly ,xll'bulldings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block pumber or description according to deed, and show street names and indicate whether terior or corner lot. : TATI~OFNEWY~RK,, -- ,SS O NZ¥ OF f zTc/ (Name of individual signing contract) Dove named, i being duly sworn, deposes and says that he is the applicant e is the (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duI'y authorized to per£orm or have performed the said work and to make and file this >plication; tliat all statements cont/fined in this application are true to tlie best of his knowledge and belief; and that the 'ork will be performed in the m~ne:r set forth ~ the application filed therewith. worn to before m~is ota, Publ~~ '~~ ... County -~ JUDITH T, TERRY I ~ X ~ , N~a~ Public, State of New:York~z ~/~, ~,~ ~ ~ [/~ ~_' ' .o. .... ...... ~mmisslon Expires March 30, 1 ~ '~ .~ (Si~ture of applicant)