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Home My WebLink About11132-z TOWN OF!~ BUIL ,N TOWN HALL~, $OUTHOLD, N~ Y~ ~ BUILDING FER~IT (.THIS PERM'I.T MUS.T BE KEP.T ON T, HE PRI=~IS~S UNT L F~ULL COMPLETION OF THE WORK ^UTH~RIZED) Permission is hereby granted to: County Tax Map NO. 1(~00 Section .'"'~":~'"~'""i' BIock~ i...~ pursuant to application Building Inspector. Fee $...~ ......... i' ......... Rev. 6/30/80 ~., ~nd opproved by the /Sulldlng ~ Inspecfor FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Application No ~//-* ~ ~xamined . . .~.'~.' .... , 1 ipproved ./. ~7..d/.. ~ · ~ / '~zj' ~ ·.., l~.d'. Permit No.~ ........... )isapproved a/c .......................... ~ ...... 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 be drawn on the diagram which is part of this appli- ,alien. 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 purpose 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ,dm~t authorized inspectors on premises and in buildings for necessa~ inspections. ~ ............. .~.S...,~...~..~/.ignature of applicant, or name. ifa corporation) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ -~ t (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 ......................... Electrician's License No ........................ Other Trade's License No ...................... 1. Location of land on which proposed work will be done./~ ................................................. ................. .... House Number / Street County TaxMap No. 1000 Section .¢~. ............. Block ...... ¢ ........ Lot~21~.~. ............. Subdivision ............ .~.Z.~. .................. Filed Map No .............................. / (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................... b. Intended use and occupancy .................... ~, ............. .~)~.. (2. .... Nature of work (check which applicable): New Building'. ......... Addition .......... Alteratioll .......... Repair ............... Removal ............. Demolition .............. Other Work./7~'~/~__~. ~... 5 If dwelling number of dwelling units (to be paid on filing this application) Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... L If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ...................... 7. Dimensions of existing .structure~, if any: Front ............... Rear .............. Depth ............... Height' . .............. Num:ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .. ................... ... Height ...................... Number of Stories ........ 3. Dimensions of.et~tire new construction: Front ........ Rear ...... Depth ~ Height .'~./-~....' ..... N~mbero~Stories ........ iiiiiii ..... iiiiiii...ii .................. 7. Size of lot: F~nt ........... [ ........... Rear ...................... Depth ...................... ). Date of Purchase ........... ! .................. Nam, e of Fola'aer Owner .................... . ......... ~ .... chpr~m' ' 'tuated ~~.~.. ' ' 1. Zone or use dlstr~ct m wh.~ ~ses are 81 ....... - ~. ,-- ~ .......................... 2. Does proposed construcnon viol'ate any zoning law, ordmance or regular'ion ................... ' t. Will lot be. regraded ...'TT~...~ .h ....... t~. · ~f ...... Will excess fill be~r~mov~_dt fj~om premises:.~ · .Name of Owner of premises ,2~t~L~., ,/~,~..t. ddress-~.~.~.~h~ ~L-Phone No.~. ~..~L. .~. Ntune of Architect ............... ~ d .....~ ..... Address ................... Phone No ................ Name of Contractor/~~. ~., .C:~/~--~-Address .'/ ......... './...'?... Phone No .............. PLOT DIAGRAM Locate 'clearly and distinctly all! buildings, whether existing or proposed, and, indicate ail set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. FATE OF NEW YORK, . (Name of individual sig~ing contract) ~ove named. , (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 9plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ,ork will be performed in the mann6r set forth in the application filed therewith. worn to before me this ....~./~..~..~..day o~..~4 ......... ,19°~.../ f apphcant).