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Home My WebLink About14357-zFIE :CTION 1. FOUNDATION (2nd) 2. HOUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: FOR~ NO. ~ 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 AUTHORIZED) No 14357 Z Permission is hereby granted to: j/~ . /) ~oy~ ~ .c7 . . . ,::::~....~....~,.~,....zz..~..~.~ ..... -7'= .......................... .............. ............... at premises located at ...~.~.. ...................... ;.....~......~. ...... '~..~...s~~ ............. County Tax Map No. 1000 Section ..... ..(~......~...~.. ...... Block ..... .~....~.... ....... Lot No...~..~ ............. pursuant 'o application dated ...~.~....~,.D. .................... / 19..~...&.., and approved by the Building Inspector. ~ector Rev. 6/30/80 Examined .~ .[g..., 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~-,OUTHOLD, N,Y, 11971 TEL,,' 765-1802 Approved .O.~..I.~...., 19~.~. Permit No./.~ .~...~.~. .~... Received ........... ,19... Disapproved a/c ..................................... (Build~g 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 ~ Certificate of Occupancy i 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 tke construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,.b),~~)~.ng c,.~e, .and regul;tions, and to admit authorized inspectors on premises and in building for necessary ~~ .~___ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ~%.' ~:..,~. --~ ............... .//. ............................. Name of owner of premises ...... : .................. q-~.> ·: · · O..~"'7-~'~' '~~:q4' ' '~' · ' .................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of/c°rp°rate officer) Builder's License No... ~.~../~¥-t. r2. ~....~--../:.t.o..~.~.. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License Ne .................. ~ ///,/,,,., ,/ 1. Location of land on whic, ,roposed~ ~~, -~ work will be done .................. ~~~L~7'/0".., ............. naa;a ....... .... a;.;;; .................... ' =Hamlet ................. oun , T.x =., So. 000 Se., on ....... ...... ......... .... ..... L ......... 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 and occupancy. ~~~. Addition 3. Nature of work (check which applicable): New Building .................... Alterati/o~? _ 7' · .i ..... Repair ........ .)~...... R~.z~ff~..., .... Demolitim} . .ff~.j. Other Work .f~//d-C~.(/C' ..... '~' V'~45z,,-~-t,~ ~,~&-~,~/ ~ ~, ~q)escription) 4. Estimated Cost ...................................... Fee .... ,~...~.~.*.'.~.".'~. .................... ~' (to ~e paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling u~tts on each floor ................ If garage, number of cars .......................................... ~ ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......... ~ .......... 7. Dnnensmns of existing structures, ff any: Front ...... ~ ~'. ..... Rear .. ~. ~ ........ Depth/'5~. ............ Height ...... ./.c~. ..... Number of Stories ....... J .................. ~ ......................... Dimensions of~a,.n)e/structure with alterations or additions: Front .... ~'" ~" i ...... Rear .. ~.. ~ ./. ......... Depth ...... ( .'Z ............. Height ...................... Number Of Stories ...................... 8. Dimensions. of entire,, new construction: Front ............... Rear ...... ! ........ Depth ............... Hamht ...... ~'~ ....... Number of Stones ...... 9. Size of lot: Front ..... ~/ .............., Rear ..... ~..O..~ .......... ; Depth . ./. ~.~. ............... .......... .~ . ./_.~ . / .......... ~ ..................... 10. ~;tnee°ofrPu~;C~s~;ictinwhi~t~re~s s~te . i:,~,~.: ......:: ..... i'!':: ...... ated .... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ??..cC. ...................... 13. Will lot be regraded ......... ..,a~,~.~ .....j ...../.. Will excess.fill 14. Name of Owner of premises .....~. :.~?.'..'T.~/t?//~.~ .~Address ././L)~~... Phone No...~:~..d~.../.~.q{ .~t~/. Name of Architect ........................... Address ............. :C/ Phone No ................ Na~ue of Contractor .......................... Address ................... Phone No ................ 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 number or descrip~t~.n acc~rding to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWrYORI~,/ /// S.S COUNTY OF.. ~ .~.d~.~./{._<2~ ~'~/~ .............. ~ .,.. (~.:.i ~..../~'/~q....g~...Qr. ..... being duly sworn, d~poses and says that he is the applicant (Name of individual signing contract) above named. Heis the ............................... {~-.. ~ .(~.. ~."~-t.~ ............ i .............................. (Contractor, agent, corporate officer, et~.) of said ownei or owners, and is duly authorized to perform or have performed thc 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 ; ................. day of...~"..c.-5.~.?.~.t .... ~. .... , 19.. Notary Public, ........... NOTARY PI.I~.IC, 8tree of New Yo~.,/ No. 4~, ~k~f~lk CountvJ,//~ ........ County .......... . :~:;?~...~' ,/~.~/ // · . ~.~-~.~.,~____~ -, ,,- r': . .~ · .,..I_ ~.--~ ................. I" .... / .(Signature of applicant)