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Home My WebLink About14091-zFi~LD %~SPECTION COMMENTS rOUND.ION (lst) FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14091 Z Permission is hereby granted~to: .... ............... ! .................................. · ' m ........................... ~ ....................................... CJ' ..................... I)' ................................................. at premises located at ..,J~..~2.,~....~.....~.: ....... 1.~..,)..~, ..~,.. ........................ ,County Tax Map No. 1000 Section ..... )...,~..Z ......... Block ..... ...~...~ ..... Lot No....~.J..~...Z ......... pursuant to application doted ...~...~,,...~....~ ........................ , 19.~......,., and approved by the Building Inspector. Fee $...~.. ................... Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLE BUILDING DEPARTMEr TOWN HALL ~OUTHOLD, N.Y. 1197 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Receive ........ Date . .~.~..'?.~...27..4 ....... 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 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 appilcable laws, ordinances, building cQde, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. __ ~ · .~.~..~.~..,3:~.'.-.~c....~m.. ~..~.. .......... (Signature of applicant, or name, if a corporation) .....,~.... f~ .~..,,p/. ~ ~,.z:.~+. .................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ~..~.....~...~...3.~??.~'.~...~.. ~:..~ ................................................... Name of owner of premises . .~.~.~....'3.~e~...3..~....~.-...~.~....~:~.. ........................................ (as on the tax roll or latest deed) If a~ is a corpor~ion, signature of duly authorized officer. Builder s License No ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ../~.~ ../¢,.. ~.~..~.*...~...~. ~...~..:,..~...,~.. ~. I~ouse Nu~er Street ...... ~t~n'l~ ........................ County Tax Map No. 1000 Section . ./.4f..] ............. Block .~ ............... Lot ~}' [ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy 9~,premises and intended use and occupanc~y,,of proposed construction: a. Existing use and occupancy...Z-).2: r.a.~:~..~.~<.%......~b/, q.~.~.q'. .~..~./.~...~. tjx/7...~.~..C./*.c/? .F~.. 7 .g./. .............. b. Intended use and occupancy ,~C~ ' , 9. 10. 11. 12. 13. 14. Nature of work {~3~'v~/idff a~'pli~/~ble): New Building .......... Addition .......... Alteration .......... Rep/dr .......... II~ ~?~lIJl · .5 ........... Demolition .............. Other Work..-~.~.~%..../~.,.t (Description) estimated Cost,..'¢ P.°.? ................... Fee ...................................... (to be paid on filing this application) If d~veiling, number of dwelling units ............. Number of dwelling units on each floor ................ If garage, number of cars ..., ........ If business, commercial or mixbd occupancyl ~d'ff; 'n'ai~e'~d'e~dn't'df'd~c'h'(~p'e'~i~e' iiiiiiiiiiiiiiiiii Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............ Height ............... Nu~nber of Stories ..................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth .................. i · · · Height ...................... Number of Stories ................... Dimensions of entire new construction: Front ............... Rear ... Height ............... Number of Stories .................. Size 0f lot: Front ..... ~ ..~ ............ Rear. Date of Purchase ........ i ................... Name Zone or use district in which premises are situated Does proposed Will lot be regraded .. ~..o.. 2 ................ Name of Owner of premises .W...f.. Name of Architect .......... i ................ Add Name of Contractor ~Q~.r~'.~. ~ :. .. '="~t)''"t~'t~' ....... ..... Depth .............. ~ ds ~s: Yes (~' PLOT Locate clearly and distinctly all buildings, whether existing or and, indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED DATE: '~///~ B.P. ~: /.(/~c~/ :~ FEE:~_:__~____B¥: V ~./- · NOTIFY BUILDIN~ DEP~RT/~ENT AT 7&5-}$0~ 9 ^h~ TO ~ P~ FOR THE 1. EOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGFI - ~ & PLUM,jBtNG STATE OF NEW YORK, S.S COUNTY OF ................. 3, INSULATION 4, FINAL ~- COI'¢STRUCTION--MUST BE COt',API..FTE FOR C, O. ALL CONSTRUCTION SHALL- MEET THE REQLIIREMENTS OF THE N, Y, ~TATE CONSTRUCTION & ENERGY CODES. ~OT RESPONSIBLE FOR ............................ : ..................... 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 dqly 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 mannbr set forth in the application filed therewith. Sworn to before me this NOTARY PUllL~C, State o New Yolk No, 47078'~8, Suff¢~ C0un~'~ ~ °" ~ ....................... Term Exo,ree uarcI' 30, 19~.7 / ...... ' ~;e of applicant)