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Home My WebLink About15115-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG P E P~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15115 Z ot premises located at ............ : .............................................. Count~ Tax Map No. 1000 Section .... ..C~....~,.,.~ ......... Block ...... .~....~=. ....... Lot No......(~....~. ........... pursuont to opplication dated ................. ..~.....~ /...~.. ........................ , 19.~...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 ~'-'~* ; ........ PLOT DIAGRAM /.~....a~..~,~ o~,,a~l,,.._nnd distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from [ccording to deed, and show street names and indicate whether /S-o~ STATE OF NEW Y,.OI~K, S S counTY OF .... ~"7'" ' <---- ,. .. ~.~? ..... / ...... ~ ~'t4'.;tZ ................... being huly ~worn, deposes and ~ays that he is the applicant (Name of individual signing contract) above named. .~ ~ ~h~ ......... 0.~ ~.~. . . ~ . . ~.Z .... ~.4~ .... ~Z~ . . .~d 55. . . ~ J d;~. . . .... : .... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly' authorized to perform or have perfo~ed the s~ ork~s ' and to make~ and file this application; that all statements contained in this application are true to the best of h wle~e-and b~ef; and that the' work will be performed in the manner set forth in the application flied therewit~ Sworn to before me this .... ............. .............. Nota~ Public, ~:~ ~... ~'2'. ...... Count~ . ~.TH t~a~;a . · · . .............. ' k ~m eu~*,~, st~,, ,~ ~l~w ~ ignature ofapplic~t) FIELD I~S~'ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-180:2 Examined..~ .t .~ ..... 19~..~. Approved.~ . I .l~. .... 19~.~. Permit No,/.~'~. ~. t .~.~...~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........ ..,19... Date ............. ' ......19... INSTRUCTIONS J a. This application must be completely filled in by typewriter or in ink and submitted to the Building Ingpector, 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 regulations, and to admit authorized inspectors on premises and in building fer necessary insp~t~s. 4 CZ ( i~(~ a!~ure of_applicant, or nee, if..a corporation) -.. ... ................... /, ........ (mailing ~ddress of applzcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... ~.O.~..~.. .~/'/~0.P~..~.d ..... ~..~J~....~. ............................ .......... (as on the tax roll ~r latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... ' 1. Location of land on which proposed work will be done ........ ~ .... ~../4....~.. ~./,.t .~.,/.~ .f~..t~ .......... ...2.7.r'. ............. ..... ....... ........ ...... ' .......... House Number Street Hamlet County Tax Map No. 1000 Section .... ~..'~. ......... Block .... ~ .... i'. .... Lot':.. :.-~....' .......... ' Subdivision .............. (~q'a~;) ................ Filed Map No...}1 ~ ....... Lot... l.~ ......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.14../~..~..F~.. ..... ['. · .~.. ~.~. ........................................ b. Intended use and occupancy ..... .~'.O..~! .~. ........~.~./..~. · ......~..o.T. .... ~..~..~...O. ~./~Zf). .... 3. Nature of work (check which 4pplicable): New Building .. Xr/f~.r~.. 'Addition .......... Alteration .......... Repair .............. Re~noval .............. Demolition .............. Other Work ............... .~...2,..0X~.. (Description) 4. Est~ated Cost ....... ~ .......................... Fee ..................................... : ~ . ~ C&~C (to be paid on fihng this application) ' g, mberofdwellingun's .. ~ n berofcars ...;.~ .... ~3~ ............. 6. If business, commercial or mix,ed oc~oancy, specify nature and extent of each type of use . ~.. ~oA(~.~... 7. Dimensions of e~isting stm, ~s : Frgnt.. ~.. ~ ..... Rear .. ~. 2 ~ .... De . ~, Y~ ..... Depth...C74~ [ ~. [ ~ei~.[¢,~ ............ Number of Stories ...................... · o, , 8. D~ensio~Fe~e ~ cl : t .... J /~.~ .......... Rear ..... /~. ........ Depth ........... Height ...~.~ .}~ n~'~[~s ..... a~ ............................................. 9. Size of lot: ~., ~.~ ,. ~. Rear... ~. ]J:O' ~- ' : .............. Depth . ,: ....... ~ 11. Zone or use dis~in ~ t ...................................... any oning l w, o dinan o lation: . ......................... 13. Will lot be regrad~l ...... ~, .................... Will excess fill be removed from premises: ~Ye~ 14. Nme of Owner of premises. ~.. ~:..~. Address. ~..~¢~..~*. Phone No~/{ .~ I.g~Z.. Nme of Architect . . . ~iO ~ ...... {. Address ............. Phone No... ~ ' Nme of Contractor ' Address Phone No 15. Is chis property located ~ithin ~00 geet of a tidal ~etland? * Yes ..... No .~.. i · If yes, Southold Tom Trustees Permit may be required. , PLOT DIAG~M Locate cle~ly ~d distinctly ~1 buildhgs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from property ~nes. Give street and bloc r number or description accord~g to deed, ~d show street names and indicate whether interior or comer lot. STATE OF NEW Y~K, S S - COUNTY OF .... ~o .... ' 0 WO~ ................................................. being duIy sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named., He is the ......... 0.~ .~ j.. ~.. ~.~ ........ ~/~...~ ~.. (Contractor, agent, corporate officer,, etc.) of said. owner or owners, ~d is dhly autho~zed to perform or have perfo~ed the said work and to m~e and file this appllcatmn; that all statements contaneO' ~ this application are true to the best of his.knowledge'-and belief and that th{~ work' 'W~i 'be perfo~ed in the maher sci,forth ~ the application filed therewith. Sworn to before me this .... ~. ................ day of..~ .............. 19~ ....'