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Home My WebLink About12866-z FORM NO. 2 TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERI, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK A. UTHORIZED} 12866 Z Permission is hereby granted,--t°: /j:~,,~ ~...~.. ~*C) ....... /.(W./..~... .~.... ........... ~,~,... ..................... .... ~C2.,. .... //..~ ~... .~./.. ... . /.. .v..o.. .~. z¢ , .... ,a ...... ~2.~.~./~.a~....~. .................. ~d:~...-..~ .......... .~..a ....................... ...~.:,~.~ ............. ~:~.~......~:.....~.~.~_~ ..................... ~...:.. .......... at premises located at ....J~..d~..~....~-~Z.Z. ZT'..~,~/..~.......-.~,~,,-~,~,..-:~,-'--..-~-~1~-.~ '~ County Tax Map No. 1000 Section ....~....?.~... ..... BIo~k ..... ~.....~.. ...... Lot No.......~......~..'~...~...... pursuant to application dated ...; .~..~/.~f~...~..i~..'~.. .......... , 19.Z~., and approved by the Building Inspector. // Rev. 6/30/80 FIELD I-NS F~STION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY 20DE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 ~×amiued .~.~.'~.. ~ ....... l~-':- Approved .~.c~.~.-~?..~. ....... , l~me~it No ' ~ ' -~ Disapproved a/c :~ .. ;~22.L:.: .; :.:.:..,.~ ............. .. · ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Received. ~.Z/. .... ,1 9~.. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 issued a Building Permit to the applicant. Such permit shall 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 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu!ations, and to :~dmit authorized inspectors on premises and in building for necessary inspeetj~ons. i..--:../.~./~.....-~.~.~..~. .... .~:.'.~,<.e... ¥.'4 ......... (Signature of applicant, or name, if a corporation) · ./T& .~. ?r.'... ~../../~.~.~.~7:..~ ~:~. ~ ~? (Mailing address of applicant) //q.~2- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... c"'v~.q?~.~. ~.v<~ ........................................................................... Nalne of owner of premises ...... ,.~..~'-~...X~. ........................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ............ .C/./¥.'q ..... ./w.<.~ ..... ~ ............. · (Name and title of corporat~ officer) Builder's License No .......... ./*..5: ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ......... 4. ... . . . ./. .................... ....... X;. ~:. . . ./.:.:',.,,. /z:~/,.,~. . 6'/~:.,. . . ~ ltouse Number Street Hamlet County Tax Map No. 1000 Section ....... ~ ..~. ...... Block '-~ Lot..~.'~( Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~./.~.~ .... ./.?/~.z.~/./?.j(..;i~t~4.~.~{t!~.~ ................................ b. Intended use and occupancy ................ [' ' :2: :.'X~',~'rz~:.';'~,,,' ............................ 3. Nature of work (check which a'pplicable): New Building ...... t .... Addition .......... Alteration,.. .......... Repair .............. Removal .............. Demolition .............. Other Work...,f'-.~q~).~. .... '~ '// o (Descrip'(ion) 4. Estimated Cost ..... .~. ~ ...................... Fee ..... .~../ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, hum bet of cars .... i .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .. Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimehsions of same structure w~th alterations or additions: Front ' Rear .................. Depth ................... i. · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .......... : ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ' / ..... O ( 2c~,e * 9..Size of lot: Front ......... .~..O. .......... Rear ..... ~ .......... Depth ...................... I0. Date of Purchase .......... i ................... Name of Former Owner ............................. l 1. Zone or use district in which p~emises, are situated .. .................................................. . 12. Does proposed construction vi01ate any zoning law, ordinance or regulafion: ................................ 13. Will lot be regraded : . Will excess fill be removed from premises: Yes No Name o f Architect ' Address .C'o ~..~..,t,.,~Phone No Name of Contractor Address Phone No Locate clearly and distinctly ali property lipes. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or d~scfiption according to deed, and show names and indicate whether above nanled. Ile is the..: .................................................................... (Contractor, agent, corporate officer, etc.) ot sa,d owner or owners and ~s duly acthp?zed to perform or have performed the said work and to make and file this application; that all statements con~ain'ed'~hi 'this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... Notatz Public~~ .............. ............ ~Z.. ~;~ ............... being duly sworn, deposes and says that he is the applicant ' (Name of individual sign:ing ~ntract)