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Home My WebLink About11122-z BUILDING TOWN BALL SOUTHOLD, N~ Y.~ BUILDiNg- ~E~IT~ , (THIS PERMIT MUST BE KEPT ON ~HE PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED~ N? 11122 'Z mt~ ........................... ~. Permission s hereby granted to;~ ,, ............ ..... ~iZ.~;.....~:.~, ................. ~o ........ ~(G~.~Z-~.¢ ~: ~L ..,..~r%~x~.c,~ .............. ;...4 ................. ~ ........................................ ~ ~o~,~, ~o=~o~ ~..z.~..~ ........ ~.~.~..~..~. ................ ............ ~:, .~c~...-:~...:..~. co~ ,~ ~op ~o. ~0oo so~,o~ Z.~...~ ...... ... ~k ~. .~ .......... ~o~ uo,-r~-~¢-7 ....... Building Inspector. Fee $. ~./...~ .............. Rev. 6/30/80 InSPector FOUNDATION (ls6) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE FINAL " ¢ ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, 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 streets )r areas, and giving a detailed description of layout of property must bi drawn on the diagram which is part of this appli- ,ation. 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 ~hall 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 purpo~ whatever until a Certificate of Occupancy ;hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~rd~me i~Pa~uli~n~z~riCnesSpteOct~;s%~ lnSrV~itm~s:sl aanP~liinC~)bulildlian~:, fOorrdninecaens;~/~islp~!!lo(n(~~ regulatiols, and to ~re of applicant, or uame, if 'a 'c;;~;]'atio'~) .... (Mailing address of applicant) Ctate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ................................................................................ qmne of owner of p,emises...~-~..a...,:..fi.. ?. 5...~...~. ~ ~.~..~....~..~.~. ~..~...~..'-: .............................. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ...... .~.(.~.D..~.)..'~., !.~. ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade*s License No ...................... / Location of land on which proposed work will be done...~..."~......~.f. ~.~'.t~'2'?.':~.''. . . ~ ~ ~.': . 7..~. ~ .t.~ ~.{~.. House Number Street Hamlet o,nt ,000. ..... ........... ........... Subdivision ..................................... Filed Map No .............. Lot ............... (Nmne) * State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~ .h..~..h~....~. ........ '5 ~, .~. ~,.~5 .~..~)..0~.~. ............................ b. Intended use and occupancy ....... 5..~..t~'..'~....~..~.~. ~. ~_,.~.'~'~ //' ............................ . Nature of work (check which applicable): New Building'. ......... Addition .......... Alteration ....... Repair .............. Remo.vai .............. Demolition .............. Other Work...~'..~ .~-2.%:~_... Estimated Cost ...................... Fee .......................... ~ ........... (to be paid on filing this application) If dwelling, number of dwelling ~nits ............. Number of dweliing units on each floor ................ If garage, number of cars ..... . ................................................................... If business, commercial or mixed occupancy specify nature and extent of each type of use .................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. +]eight Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... ~.. Height ...................... Number of Stories ..................... · Front Rear Depth Dimensions of entire new construction ............................................ Height ............... Number of Stories ........................................................ Date of Purchase ...~/~..°.... .................. Name of Former Owner .... ~.T'. ~cf..~.a.t.~.~ .......... Zone or use dasmct in whteh premases are mtuated ................................................ Does proposed construction viol'ate any zoning law, ordinance or regulation: ...... .~.7...O ...................... Will lot be regraded . ..YO. O.... ............. . ......Will excess fill be reinsured from premises: ~ No Name of Owner of premises .-'Z~:. ~?. gfi. C~ ~..~ .... Address [ ~ 7..0 .~./~/ff/~ellea... Phone No..~.~-~. $ .~? Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor .... ~t4..~.O~ ............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly dill buildings, whether existing or proposed, and, indicate all set-back dimensions from ~operty lines. Give street and block number or description according to deed, and show street names and indicate whether .terior or corner lot. £ rATE OF NEW YORK,,-i~ 'OUNTY OF..~. H.~..~9. ~.((. .~ ..... i a'a ..... i .................... being uly *worn, deposes and says that he is the applicant (Name of individual s~g~ing contract) Cove n. amed. is the ......... .O...~...~..~'. ~ ................................................................... (Contractor, agent, corporate officer, etc.) said owner or owning, and is du!y authorized to perform or have performed the said work and to make and f'fle this pplication'; that all statements contained in this application are true to the b6st of his knowledge and belief; and that the zork will be performed in the manner set forth in the application filed therewith. worn to before me this ..... ~ ............. day of ............... , ,ota,~P4iblie, ....... ,~/.~3. %,..~.~..~,...~County _ ; ~' ~OTfCRV PUBLIC, State of New Yod~/ ' '~'/' T ........... ('~'~ ;'~?' ': .... '~ ' ' ";c '" L~]gnature oI appll and rio. 52-8125850, Suffolk C~.L/ , : Term Expires March 30, 19~;~:~