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Home My WebLink About13159-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13159 Z Permission is hereby granted to: ...... ...... ...... ~.,.~.~.../.........,~. ....... ~...~,, ..... ....... ,~.o.z'.~./.~.~.=..~...~ ...... ~o ......... ~..~.... ....... ~...c..~.:.(. ...................................................................................... .............. .'... ...... ~.~_~.~ County TaX Map No. 1000 Section ..(~..~...Z ....... Block ...~..~. .......... Lot No. (~)../...:..Z... pursuant to application dated ................................ , 19. and approved by the Building Inspector. Fee ,.../....~.....~ Rev. 6/30/80 FIELD, INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: N, SZ°53 EUGENE'S 108.00 RO~ D FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved ermit No.. v (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19. · · 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 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, ¢s--l~rein described. The applicant agrees to comply with all applicable laws, ordinances, buildin~ code, housin~ cod0~ andXr, e~u'[ations, and to admit authorized inspectors on premises and in building for necessary inspee'fi'~ ~ q~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.O..~../~..~.~..~.l..~.../....~l~...~.. ~'103.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. .ri: '-]O(.o ~ Electrician's License No...ff.~.~.r~.~. ........... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet Coanty Ta× Map No. 1000 Section ...O. -C}..'7 ........ Block .... . .Q .(.a. ........ Lot..¢).O.!:..0.0.1 ...... S '~r)lBioOx {~Cf~ .~4 0~[.-~ .~l~ap No..(.J~.q. mot .I. uocnVlslon .................................................... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy... · · .l~f~.. · · · .?."h~. · .'~ .~.~...k'~.. ............................... b. Intended use and occupancTK_ ~,a~~....(~2:...'~..'-~..4~...~. ~.'~,~|~ .~/......[~...~/~..b ...... Repair .... ~RI)I q' '1' ¥1il~e~X~4 .............. Demolition .............. Other Work./~.C~.O.,.~:~.,.. . , ........ ~ []/~ ./ . ~ ~ (Description) ~_~0~0'~,~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling,units ............... Number of dwelling units on each floor ................ If garage, number of c~s .... ~ ................................................................... 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctur6s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ l)~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. ~ I)epth . .................. ;.. HeiSt ...................... Number of Sto~es ...................... I)imensions of entire new cpnst~ction: Front ............... Rear ............... Depth ............... ~,~ze of o. Front ... 1~ ......... ~ear...13.h. l ~ ...........Depth ...~9.~t .~ ........... 10. Date of Purchase .......... ; .................. ~ame of Foyer Owner ............................. ~ Zope or use district in which pr~mises are situated ?~ t. ~~[,.~~[ ~ .... ~Does proposed construction violate any zoning law, ordinance or regulation': ~ ~.Q~ ~ ~. ~W~I lot be regraded ...... ~a h'2 .... - ....... a .... Will e3~[ ~11 be removed from premises: Yes No [14. ~ame of Owner oC premises ~[~.~ 1.~.O.. Addres~ ./.~~hone o.77.q:Tq, ..... Nme of Contractor~ ~ ............ Address .~0.~'~.. Phone No. 7~: ~¢.~... .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block interior or corner lot. number or description according to deed, and show street names and indicate whether STATE OF NEW ycy~, __ /'_ _ COUNTY OF...~ S.~ ~ , /} ....... ..~..~~ .,/f~..~. beingduly sworn, deposesand saysthatheistheapplicant · (Nome of individual sign'ilf~-eontract) above named. He is the ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 b~ performed in the manner set forth in the application filed therewith. Sworn to before me this : · ........... ..... ....... 19. ¢