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Home My WebLink About15654-zOUND~TION (l~t) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITZONAL COMMENTS: TOWN 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 A. UTHORIZED) N~ 15654 Z Perm~ss,on is hereby granted to' ...~ ........................................... ,~.~..~.~ ....~..;~..~.~e.... ...... ~.~....g~... ................................ ~~ ~ . l q~ ..... .................... :~ ........ ~ ......... ) ....... ,o ...~.....~...~..~~.~....~...~ ............... ................................................... ..................... ~ ~~~~ ~,~ ,~ed ~...~ ......................... ~'. ............. ~ ...... ~ ................ 19.~..'].., 0uildlng Inspector. County Tax Map No 1000 Sect,on ..... (~).~t~.~. ...... Block .......~..~. ........ Lot No.. ~..o...L~.... ~. ond opproved by the Building Inspector Rev 6/30/80 Exam reed .~ .Oe'y,~-~'~ ~ Approved Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.. 765-1803 BOARD OF HEALTH 3 SETS 0~ PLANS SURVEY CHECK SEPTIC FORM NOTIFY CALL MAIL TO: Permit No .] ~.'7b ..~'~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ , 19. INSTRUCTIONS a. Tl~s apphcat]on must be completely filled m by typewriter or m ink and submitted to the Bmldmg Inspector, w~th 3 sets of plans accurate plot plan to {cale Fee according to schedule b Plot plan showmg location 'of lot and of buddings on premises, relahonshlp to adjoining premmes or pubhc streets or areas, and giving a detmled descmption of layout of property must be drawn on the diagram whmh is part of this appli- cation. c. The work covered by flus apphcation may not be commenced before issuance of Bmldmg Permit. d. Upon approval of this apphgahon, the Building Inspector will issued a Budding Permit to the apphcant Such permit shall be kept on the premises available for mspechon throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever until a Cerhficate of Occupancy shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldmg Permit pursuant to the Building Zone Ordinance of the Tswn of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction ¢f bmldmgs, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply wlth all apphcable laws, ordinances, building code, housing code, and regulations, and to admltauth°rlzedlnspect°rs°nprermsesandinbmldmgf°rnecessaryms~ptgft~,~--'~- //~.,7-fd)_.~v ~..~.Cq_~z ..,~c~,~. -..,.z~.~.-C~i~A~... -~t. .......... (Signature of ap2h~nt, or name, if a corporation) (Mailing address of apphcant) State whether apphcant is owner,I lessee, agent, architect, engineer, general contractor, electncmn, plumber or builder. Nameofownerofpremlses .~c~_'/~...~.F~,-~ ~t~-~.~x>-vt~- ".~/.~.O~.i..]~.~.il..il ii .'ii iii i i.ii (as on the tax roll or latest deed) If apphcant m 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 L~cense No 1. Location of land on which proposed work wall be done .... , ..... ~ ......... ¥ o , . . , ,, .............. 2 House Number Street Hamlet County Tax Map No 1000Section DE.,~ Block. ~' ..... Lot. ~(?t).?Z'~ .. Subd~vmion ........ Fried Map No Lot ......... (Name) State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construchon a Existing use and occupancy ~ e c ~ ,. ,~ ..-----~. ...................... b In~-'nde~'ase and occupancy ................................... 3. Noature of work (check which applicable) New Budding ~ . . Addition ..... Alteration Rep:hr Removal ........ Demolition .......... Other Work . .. I --,O~ (Description) 4. Estimated Cost ..,/~.Z$.':'~?'~. ........... Fee .......................... ~1 " (to be paid on filing this apphcation) 5. If dwelling, number of dwe~lmg umts ........... Number of dwelling umts on each floor .... , · ./3 .... Ifgarage, number of carsI ...................................... ~~-. · 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .~~,. .. ?. Dnnenslonso£exmtmgstru tctctcz~res~ffany Front ~ .... Rear . ~ ........ uepth .......... Height ~umber of Sto~es . .-A-z ........................ D~nenmons of same structure w~th alteratmns or addmons Front .......... Rear ............ Depth , Height ....... Number of Stones ................ Dnnenmons of enhre new cbnstruchon: Front .. ~ ...... Rear .... 2~. ........ Depth . ( . ....... Height /~: ~ . .iNumber of Stones /. 9. Size of lot Front o~.'5 eL .- Rear . . Depth . . 10 Date of Purchase . .. ~-f., .l/~'~ .... Name of Former Owner .. ~ ,4~//<-.~ ......... 1 1 Zone or use d~stnct in which premises are mtuated.. ~1~.~ .................................. 12. Does proposed construction violate any zoning law, ordihJance or regulation . ~ d ................... 13. Will lot be regraded . . I. -_ . .~- .~ ......... Will excess fill be.retook, ed from premises. Yes 14 NameofOwnerofprem~se~ ,~,..(~f'- .*P..' ..... Address~/~/4~'.,~.,~4.~ tt~.~ .... PhoneNo. ~'~5~ Name of Architect ... I ............. Address ................. Phone No ......... Name of Contractor i . Address Phone No 15. Is this property located within 300 feet of a tidal wetland? ~Yes ..... No . .~-~.. · If yes, Southold TownlTrustees Permit maybe requzred. ~ PLO*F DIAGRAM Locate clearly and distinctly all buddmgs, whether ex~stmg or proposed, and indicate all set-back d~menmons fro property hnes G~ve street and block number or description according to deed, and show street names and indicate wheth interior or comer lot. STATE OF NEW YORK, S S COUNTY OF.. (Name of md~wdual mgmng contract) above named being duly sworn, deposes and says that he is the apphca] He is the .... (Contractor, agent, corporate officer, etc) ~ [ ~ K,~,,~,~ of smd owner or owners, ~d ~s duly authored to perform or have perfo~ed the smd work hnd to m~e ~d file tk apphcation, that all statements contmned m thru apphcatmn are true to the best of his ~owledge and behef, and that work will be perfo~ed ~n the m~ner set forth m the apphcation filed therewith Sworn to before me thru . .. /~ ...... dayof ~5~ .... 19~ Nota, Pubhc ........... ~~ ..' V C°unty .........