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Home My WebLink About11339-zTOWN OF $~)UTHOLD BUILDING D~PARTM~ TOWN HALL SOUTHOLD, N~ Y. Permission is hereby/granted to: BUILDING P, ER~IT ~ (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~' 11339 Z Date ....g ~.~.; .~.. ...... ../.. ........19,.~/ '/ County Tax Map No. 1000 Section ..././..if .......... Bilk ~...( pursUont to opplicotion dated ... .~..~.. ......... ~ .... Building Inspector. Z:....5.[:'. . Fee $.. ..... , 19~., end approved by the ? Building i Irmpeetor Rey. 6/30/80 FOUNDATION (1st FOUNDATION (2nd ROUGH FRAME PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Exam,ned . ./..~.., 19.~?. Appr°ved~' '(/~':x '7' · '/' '~' · ', 19 '~?- Pernlit N°.: (:~'::: / Dl. approved a/c ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.4/..~.~': .~. ........ INSTRUCTIONS a. Ttns application must be completely filled iu by type~vriter or in ink and submitted in triplicate to the Build~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according te schedule. b. Plot plan <howmg locatmn of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and gwmg a detailed description of layout of property must be drawn on the dla~am which is part of this apl cation. c. The work covered by fins application may not be commenced before issuance of Building Pern~it, d. Upon apprc, al of this application, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises available for inspecnon throughout the work. e No bmldmg shall be occupied or used .'n whole or in part for any pnrpose whatever until a Certificate of Occupan shall bare been granted by the Building Inspector· APPLICATION IS IIEREBY MADE to the Building Department fm the issuance ora Building Permit pursuant to t Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the cons,friction 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 piemiscs and in buildings for necessary iuspections. ...... ...... :.,. ..... (Signatttr~ of applicant, or ,lame, if aJ:orporation) (Mailiao address of applicazftLk' State whether applicant is o~vner, lessee, agent, architect, engiucer, general contractor, electrician, plumber or build, ......................................... C..-' (J (as on the tax roil or latest deed) ' If applicant ,s a corporat,on, signature of duly authorized officer. (Name and title of corpo, ate officer) Builder's License No. d?7,~. ~ ~' '~ Plumber's Licens: No ......................... Elect, ician's License No ....................... Other Trade s L~ .ense No. 1. Location of land on which proposed ~vork will be done. . .~.. .~... ......................................................... ~. ~.. ~.: .'.:~ :h' .... House Number Stm~t . ............ .... l Subd~vismn ..................................... :ded Map ~o (Name) 2 S~ate exJs~Jn8 usc aad occuomzcy o: premises a~d [n~endcd usc and occupancy o[ ~ro~osed construction: ~. :~J~an~ ~s~ ~d o~p~n~y ......... ~~. ~ ........................................... ...... ......................... 3. Nature of work (check which apt> cable): New Building .......... Addition .......... AlteratioM? .......... Repair .............. Removal .............. Demolition .............. Other Work..>j~ : . ~ Estmlated (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 .... ~ ................................................................... ~. If business, commercial or mixed occupancy, specify h~ture and extent of each type of use ..................... ~. Dimensions of existing stmctur6s, if any: Front ............... Rear .............. Depth ............... H eigb t ............... Nun~ bero f Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... Height ...................... Number of Stories ...................... i. Dimensions of entire new consteuction: Front ............... Rear ............... Depth ............... Height ............... Nmnber of Stories ......................................................... Size of lot: Front .......... , ........... Rear ............... ' ....... Depth ...................... Date of Purchase .......... q .................. Name of Former Owner ............................. Zone or use district in wtnch premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ W Il lot be regraded. ........ *~ .......... ~ x ........ , Will excess fall be ~emoved from premises: . Yes No Name of Owner of premises r .~. ~ Address ................... Phone No ................ Name of Architect ....... ~ ....... e. ......... Address ................... Phone No ..... Name of Contractor ......................... Address ................... Phone No ....... PLOT DIAG RAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number el description according to deed, and show street names and indicate whether ). 1. 2. Locate clearly and dzstinctly all roperty lines. Give street and block tenor or conler lot. TATE O F NEW/sYO/I'JAS~ ,/~ Z OUNTY O~ ..... ......... ('N;a'r/1; 'o'f'il~iIivi[14:il's}~'~iil'~s~s 'c'oi~*t;ic'ti .......... being duly sworn, depo,es and says that he is the applicant ~ove named. I e is the .................... , (Contractor, agent, corpmate officer, etc.) f said owner or owners, and is duy authorized to perform or have performed tile said work and to make and file this >plication; that all statements contlained in tills applicat on are true to the best of his knowledge and behef;and that the ork will be performed in thc manner set £orth in the apphcatmn filed therewith. worn to before me this ....... / .......... day of ......, ?./ otary Pub i ...... .,-;., ...... County .~. [~Otltry Public, State of New York No, 52.0344963 Suffolk qountyf2/t~ ................ ] ~:~mmlsslon, Explres March 30, 3,9t~..~ (Signatnre of applicant)