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Home My WebLink About12872-z l~Ou~ NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12872 Z Permission is hereby granted to: .......... Z:;:,,~:~z~: ....................... .......... z~::..../...~.~....~....: .......................... ,o ........ :~..:c: .,T.......~,~U.c,~...z..z..,J......~.~.L....~,.~::~.~....~.~......~.~......: ...... ...... ...................................................................................................... o, premises located at ....~.~'.~..~. -~......,.~x~l~x~;2~.'~'~:::;~t~J.Z~:~. ....... .,~../~ ................... County Tax Map No. 1000 Section ...~.~..~....' ....... Block ....~....~... ..... Lot No..~.~,,~. · ....... pursuent to applicotion doted ...~..~....;~.......~...~... ......... , 19.~.., ond opproved by the Building Inspector. Fee $.Z.: ................... Building Inspector Rev. 6/30/80 FIELD INSPECTION DATE COMMENTS FOUNDATION .~ (1st) FOUNDATION (2nd) m ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ..... · ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ,~f~-~.'..,( ~. ..... , 19~'.'.3~' Approved ..."..7. ...... 1 mer it Disapproved a/c .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 Bu/lding 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 regulations, and to admit authorized inspectors on premises and in building for necessary insge~t_ions.~ ~,//r,//r~q,,[~ (SignatU~re of applicant, or name, if a corporation) .~.o.~ ./ . . .~. . .~mr~.<. . ; .... ,~. . Ii (Mailing address oftapplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ~.~.~..~. ................................................................... Name of owner of premises ........ . .~..~7~...~..~....~..,. ~f~J~.d~./ff. ...................................... (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. O. ~.7~.t~. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .../O. (,. 5 .................... ~.~,~ .;.~.o.~;~...L../4. .............. ~.£Z7./..r?..c.~ ................ House Number Street Hamlet County Tax Map No. 1000 Section .... ll/.tO.O ...... Block ... O..~tO.O. ....... Lot.. t~.). ¢....0..~.~.~ ....... 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 andoccupancy ................ .~...~.~.*.LQ..~....~.~. ~ .6~..~.t3~.% ....................... b. Intended use and occupancy ......................... ./~. ? .~..~~t~.. .................. (~ Nature (check which applicable): New Building .......... Addition .......... Alteration .......... of work Repair .............. Rem6val .............. Demolition ............. Other Work... ~.I0~.~-. ~ ~ ~. ~/ff_ escription) _ (D Estimated Cost ........ ) ....................... Fee ...................................... (to be paid on filing this application) 5.If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor, If garage, nmnber of cars .... i ........................... 6.If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ...... Re D pth 7. D~menmons of ex~stmg structures, ff any: Front ............... ar .............. e ............... Height ............... Nun~ber of Stories ........................................................ r ~menmons of same structure w~th alterations or~t~ns: Front ................. Rear .................. r'-~-. Depth .................... ... Height ..... .~ ............. Number of Stories ...................... ~ Dimensions of entire new constluction: Front ............... Rear ............... Depth ............... ~ Height ...~O~.~ ff~ S~ze of lot: Front ..... ~x'~.~0 ......... Rear .... ,,~}~,.,.~.0 ......... Depth ..... ."[~O.~LJ~ ......... 1~ ~ate of Purchase ........... i .................. Name of Former Owner ............................. ~ Zone or use district in which pr~mises are situated ..................................................... Does proposed construction vio!ate any zoning law, ordinance or regulation: ........ ~]~) ..................... ,J~. Will lot be regraded ......... ! ................... Will elcess fill be removed from'~premises: Yes No ~ Name of Owner of premises..~.(.~.~ ~. ~,'~h Address ~0~ ~. ~. ....... ~[~.~.q~.'~. Phone No ~.~.".~ ......1~ . Name of Architect ............................ Address ........ I ........... Phone No..'!. ............ Name of Contractor ~ Address Phone No Locate clearly and distinctly alli buildings, w~ting or proposed, and~ indicate all set-back dimensions from property lines. Give street and block .number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, . i~ ~ CO Y OF · · ..... i ;dn'g'o'o'n't;ilti .......... being duly sworn, deposes and says that he is the applicant above named, r--., i He is the ........................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dufy authorized to perform or have performed the said work and to make and file this application; that all statements contained in 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 ~ (Signature of applicant)