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Home My WebLink About11194-zTOWN :~1~ ~UT~D;~ TOWN {HALL ~. , Ny~¢ BUILDING P,E~IT* } COMPLETIdN. OF THE WORK AUTHbRIZED) NO. 11 1 9~x Z Dote ...... "'"'~i .......... ~ ...... /" ......... ' Permissior~ is hereby granted to: ......................... ......................................... ?" ~o ............ , ...................... : ......................................... ,,: ........ :,?.!~..,.:~ ........... .! ..... , .............................. ................................................................. ~.-.~ .......... _..~.._........ .................................... at premises located at ..................................... ~ ....... ~.. ........... ~ -4 ....................... ' County Tax Map No. 1000 Section .................. 4. BIo~k ~..? ............ ,Lot No ............... ' '" 19....~,.., and approved by the pursuant to app ication doted ' B~lldlng Inspector. /5~ ~ Fee $ ........................ ~! BUlling Inspecto~ FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 .... . .~C.. . .~. . :¢:. . .C ~. (Building Inspector) 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 buildings on premises, relationship to adjoining promises or public stre~ or areas, and giving a detailed descriptiou 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 apphcation, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises available for iuspecbon 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 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 buildings, additions or alterations, of for removal or demolition, as herein descfib,- The applicant 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. -- .'. .... .... (Mailing address of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ mmc of owner of pren. s~'s ... ~ .m~...a.. ~.~.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 ...................... Location of land on which proposed work :!~ill be dr;~ne .... ...-,., .,~., .................................. ....~../. '.~..../?CgT~ .~..~..a.~..~.(.o. re.~ ................. L~. C~ .~..Cd-~ ~ .~e~ ~..../~.. ~,/. .......... House Number Street ' ttmriJ/et ' County Tax Map No. 1000 Section ................ Block ............... Lot ............... 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 ...................... .,. ,~ m ..................... b. Intended use and occupancy. ....... ............. ~ '· ' .,~ ............. ........ . Nat f k ( heckwlicb pPli bl ) N B tiding . Additi . . Alt ti . ]. ureo wot c 1 a ca e: ew u ......... on ........ era on ......... Repair .............. Remoyal .............. Demolition .......... er Work [ f ( escnption) (to be paid on filing this application) " / Numb rofd Ill gunitso achflo L If dwelling, number of dwell~ng Units .............. e we n n e or ................ Ifgarag~ number of cars i. L If business, commercial or mixed occupancy, specify n, gatu~re and extent of each typ?~0_fof use ........ ] ~_~ ....... I. Dimensions of existing structure$, if any: Front .... 4.~. ........ Rear .... ,5~..~ ...... Depth .. i .. ~. ..... Height .... 1 ,~. ~. ....... Number of Stories ...................................................... Dimensions of same structure wiih alterations or additions: Front ....... 4 ......... Rear .... ~ ......... ..... &'"-'~'entire ......... ;.. HeightFront... ....... ).k~ ...........RearNUmber*~'..6~.°f Stories. 'l~;t~' i[i Depth 3. Dimensions of. new construction: <-~..~..~ .... ,. .... ...... ...... Height .... f.~. ....... ~Ndumber of Stories ....... ]i]ii~)~ii]]i]]iii] ............. i ............. Z Size of lot: Front ........ .L) .~ ........... Rear.. Deoth ....... <~) .......... ). Date of Purchase ...... : [.~. ~ ~ ............... l~ame ~of Former Owner . .~..,. ~'. (:.~ 7 ............ 1. Zone or use district in which premises are situated ...... ~. ............................................ Z. Does proposed construction viol, ~te any zoning law, ordinance or regulation: ..~5~.O. ................. I. Will lot be regraded ...... /V'.i~ ................. Will excess fill be removed from premises: Y¢o Lr~O~ Name of Architect Address Phone No .~l~ ,% ;.~. Address ' Phone No Nmne of Contractor ............ ~ ......................................... PLOT DIAGRAM Locate clearly and distinctly alt i buildings, whether existing or proposed, and, indicate all set-back dimensions from ,_o tY lines. Give street and block gumber or description according to deed, and show street names and indicate whether r corner lot. 'rATE OF NEW YORK, ,S.S ou ¥ oF ................. .... ~0~k..~.iFI-~.....~...~. ~S~Q~ ...... being dul~ sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) ~ove named. e is the (Contractor,' TM agent, corporate officer, etc.) f said owner or ownen ~d is du~y authorized to perform or have performed the sgid work and to m~e and file pphcatmn;, that ail statements contained m th~s apphcatmn are true to the best of his B~owledge and belief; ~d that the ,ork will be performed in the m~ner set forth in the application filed therewith. worn to before me this 1 .......... ....... or... ......... , rota~ Publ~ ......... ~ ~ .......... County