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Home My WebLink About14904-zFIELD INSPECTION DATE COMMENTS FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY 4. FINAL ADDITIONAL COMMENTS: FORM ~10.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-180;] Examined. ~..../..~..., 19 .~. Approved. ~. ~...., 1F~. eermit No. Disapproved .rll.[3 G · DEPT. TOWN OF SO[ITl'fOLD Received ........... ,19... APPLICATION FoR BUILDING PERMIT INSTRUCTIONS a. This 'application must be completely filled in by typewriter Qr 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 layo,ut ~of property must be drawn on the diagram which is paFt of this appli- cation. c. The work covered by thi%.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 pmTnit ;hall be kept on the .premises available for inspection throughout the work. e. No building ifih.all be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy :hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Per, nit pursuant to the Building 'Zone Ordinance of the Town of Southold, Suffolk County, N~w York, and other applicable Laws, Ordinances or legulations, for the construction of buildings, additiohs oi' alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinahces, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspec/;ions. ,, ~ , ('g t :e of appl~ant, o£namedegaC6~grporation) ' '.'.:.,. ;. . .... .... i .,.., ~tate whether applicant is:owner, lessee, agent, architect; engineer, ~~j~ac~odr,dr~:~tricifa~, ~,lu~baenrt)or builder. '""' "i'" ...... : .... : ............................. l ..... , ...... i ..: ......... Nan]e of owner of premises . ~'~....~.. (as on the tax roll or latest deed) If applicant is a corporation, signature..o.f duly authorized officer. (Name and title of corporate officer) ' . Builder's License No ........ ".... ).b.~.. tq'g/g.t~7~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.~.~.~..~".~.l/d.~fl...'~/~ .~-rvCF_. ~ '~, 1. Location of land on which proposed work will be done .................................................. ? .57.. ................ ...... .¢. .................... ttouse Number Street "'~ Hamlet / County Tax Map No. I000 Section ...... .~ .... .. Block .......... Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ........ b. Intended use and occupancy .... ]~f '~' ¢~' O'(d/"~'3'~4 '~ ...... ~.&" .... O~..../¢c,6;?.' x ...... Repair .............. Removal . .' ............ Demolition/~-~ ....... ~ Work..r~.6 .~%~'--... ~. ~ ~'{ . ' ,,~:', (. ' .~ ~~ (Description) 4. Est~matedCos~..ff I't ......... ~.~V~/...~... Fe ........ : ........................... . . 5. If dwelling, number of dwelling units ............... Number 0f dwelling units on each floor ................ If garage, number of cars ............................................ : ........................... 5. 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 Ileight Number of Stories ~ D~ensions of same structure with alterations or additions: Front ~ Rear Depth ...................... Height ...................... Number of :Stories ..................... ~. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Number of Stories '~ Size of lot: Front ~ Rear )epth ~. Date of Purchase ............................. Name of Fomer Owner ............................ ~ Zone or use ..... :. d~stflct m whmh premises are s~tuated .................................................... L Does proposed construction violate any zoning law, ordinance or regulation: .... ' Will lot be regraded Will excess fill be removed from premises: Yes No [ Nme o'f Owner of premises Address .... ~.. Phone No Name of Architect x" Add~ ~ Phone No ............ · ............... 'eSS ................................... Nme of Contractor .......................... Address ............... , .... Phone No ............... 3. Is chis property located ~tthin 1.00 ~eee of a etdaZ wetland? v~ yes ..... No .~.. ~ If yes, Sou~hold To~ Trustees PermSt maybe requSred. PLOT DIAG~M Locate clearly ~d distinctly fll bulldogs, whether existing or proposed, and. indicate all set-back dimensions t~om 'operty lines. Give street and block number or 0escfiotion according to deed, an~ sho~ street names and indicate whether terior or corner lot. [ '~ Z~/ ~& [~'E ' I -- ATE OF NEW YORK, ~UNTY OF ................. S.S I I ~)ve named. is the ' . (Contractor, agent, corporate officer etc.) said owner or owners, and is duly authorized to perfom~ or have performed the said work and to make and file this )lication; that all statements contained in this application are true to the best of hi~ knowledge and belief; and that the rk will be performed in the manner set forth in the application filed therewith. om to beforeme th. is , ,',, .. ~tt'~- · · /~:... ~ .'ex...~..t~¢,.. County // /~-) being duly sworn, deposes and says that he is the applicant pI..A.(= [% ?J. 25/~ ,50 '-¢.,X -'zn >, ' t , F!