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Home My WebLink About14519-z 1~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~T? 14~19 Z BuiJding Inspector. Fee $ ........... u ding ns~ec or Rev, 6/30180 1.I ELD'~ INSPECTION COMMEN~S FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: ~v,,t.~:,-,,~T~ ")~, (~, //0d,~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN SOUTHOLD, N.Y, 11971 /~ TEL.: 765-1802 Examined ......... , [~_..~ D~sapproved a/c ......................... Q .......... / (Building Inspector) APPLICATION FOR BUILDING PER~,~ IT Received ........... INSTRUCTIONS a. Tiffs 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 buildh~gs 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 wkgle 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 for necessary ' ' ns. ~ (_~g/~&r_ e of applicant, or name, ifa corporation) .; State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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. "7': T; .................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location~d on which proposed work will be done .................................................. House Number Street County Tax Map No. 1000 Section . 1.~.~ ............ Block ....~(. ............ Lot ]..~.,. J. ............ Subdivision ................... ~ ............ Filed Map~. .............. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~/.q .~.~.~'..~... ~.tto d ............................................. b. Intended use and occupancy . .~w.q<~. ..... CP.~ .¢. ............................................ 3. Nature of work (check which applicable): New'Building .....'..~... Addition ... i ....... Alteration .. Repair .............. Removal '. ............. Demolition ............ i'' Other Wor~~.~ ;4. Estimated Cost ~. ~.P~..,.~..~ ........................... Fee/f~f.~...~..~ ....... ..~.~~)~.~?..~t~_ : ~ (to be p~id on filing this application) 5. Ifdwelling, number of dwelling units .............. .. Number of dwelhng umtsi on each floor If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... '7. Dimensions of existing structures, if any: Front ............... Rear ........ ' ...... Depth Height ............... Number of Stories ............................. ........................... Dimensions of same structure with alterations or additions: Front ............. i .... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front Rear ~ . Depth Height Number of Stories ' 9 Si Depth · ze of lot: Front ...................... Rear ............................................ 10. Date of Purchase ............................. Name of Former Owner . .! ............. .............. 11. Zone or use district in which premises are situated .......................... , ........................... ~ gl 12. Do s proposed construction violate any zonin aw, ordinance or regulation: ..... i ...................... 13. Will lot be regraded ..................... . ....... Will excess fill be removedifrom premises: Yes. No 14. Name of Owner of premises ~4-~.. .............. Address ................ !... Phone $o.t~..1~.[. .'2%..~...~..~. ]..~ Name of Architect ........................... Address ................ .i... Phone No ................ Name of Contractor .......................... Address ................ i. · · Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back d/me. nsions from property lines. Give street and blo'cknumber or desc, ription according to deed, and showl street names'and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .......... ,....., S,S .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 be performed in the manner set forth in the application filed therewith. Sworn to before me this · .~ / / / t \ \ \ Lot 2 -- Lot / A! Rg°$5'OO"E, 112.50' SURVEY FOR NUNZ/O R~ALE a STKPHANI~ RKALE AT CUTCNOGU? NOKN,