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Home My WebLink About11164-z TOWN P~i BUILDING TOWN ~ALL SOUTHOLD, Nm. y. BUILI~NG P, ERMIT', UNTIL ~ULL nspector B~i]ding Inspector. (THIS PER/V~?IT MUST BE KEPT ON' ~H,E I COMPLETION OF THE WORK AUTHORIZED) ~I~'? ~-1] ~ Z Dote .;,~. ....... .~.=. ................... 19.~/ ...... ...... .._.~_ . ~.~ ...... ~,~ ............ ~ ....... ; r~ } .......... ?..;....f;,~ , ............. ~'~' ...... ~ .............................. ......................................... ; ......................................... ~. ........... ~,...~,~ ....................................................... Coun~ Tox ~,~ No. ]000 $oction ........ ;.~: BIo~ ,~, . .......... ~t N0...~ ......... ursuant to a hcahon .dotod ................ ~....., 19 ~nd 9~prov~ bv the FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qOD o FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .... , 19 .o~./. Approved ........... .O...., 19 . Permit No. Disapproved a/c ................ _. '~"-T7i~'~~/ APPLICATION FOR BUILDING PERMIT Application No.. (f~(~. · . INSTRUCTIONS 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 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 apl: cation. 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 pern shall be kept ou 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildh~g 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 rite construction of buildings, additions or alterations, or .for removal or demolition, as herein describ~ The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ~. ~ (Signature of applicant= or name, if a corporation) (Mailin,, address of applicant) State whether applicant is owuer, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ..... .......................................................................... Name of owner of premises.. ~...,~..~.~. ?..7"... ~,.... ~ .... ~ r...~... ~.~ ............ (as on the tax roll or latest deed) If applicant Is a corporatmn, s~gnature of duly authorized officer. ~/~/C~/v~ /~' ~ (Name and title of corporate officer) ~g~r ~F ~ ~O~ ~]~ Plumber's Licens~ No ......................... -- /~ ~ ff~ ~P ffa~-a Other Trad~'s License No ...................... ' wm ............................... ................. .......... '' ' g House Nmn bet Street Hamlet County Tax Map No. 1000 Section ................. Block .............. Lot .......... ' Filed Map No Lot Subdiwsion ........................................................... (Na~ne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and oooupancy .......... ). 1. L I. Nature of work (check which applicable): New Building .......... Addition ....... era on .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... .............................. Fee ................... .r ........... (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 nature and extent of each type of use ................... Dimensions of existing structureg, if any: Front ............... Rear .............. Depth ............. Height Number of Stories .... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth ...................... Height ...................... Nmnber of Stories ................... Dimensions of.entire new construction: Front ........... .. .. Rear ............... Depth ............ HeiSt ............... Numiber of Stories ..................................................... Size of lot: Front ....................... Rear ...................... Depth .................... Date af Purchase ........... , .................. Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction viol,ate any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... , ................... Will excess fill be removed from prenfises: Yes No Name of Owner of premises ...~ ................. Address ................... Phone No ................ Name of Architect Address Phone No Nmne of Contractor ......... ~ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all: buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street mad block ~terior or corner lot. Ro 4 p, )umberr.~ description according to deed, and show street names and indicate whether t ~ /0~ / rATE OF NEW~YO RK, OUNWY OF ..~/d~7..~.qc./,~... ~S.S ............. . t...t ....thc appllcan~ ' (Name of individual si [~ing contract) bore named, e is the .................................................................................... (Contractor, agent, corporate officer, etc.) f said owner or ownem, ~d is duly authorized to perform or have performed tBe sgid work and to m~e and file ~is 9plication; that all statements contained ~ this application are true to the best of his ~owledge and belief; ~d that the ,ork will be performed in the m~n~r set forth in the application filed therewith. worn to before me this ...... ~..~., .... day of...:3 Publi~-~. , ~ ~ -- tota~ amaRY POBLIC, State of New York ReSiding o{ Suffolk Couilty Ho. 52.07(~030 CommiSsion ExpJros March 30, 19 (Signature of applicant)