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HomeMy WebLinkAbout13657-z l~,lt.M 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 i3657' Z Dote/~ ......... ~: ............ , County Tox Mop No. 1000 Section .,,~...~.Z ....... Block ....~...../~... ....... Lot No...~.../~.. ......... ~on, ,o o~,,~o,,on ~o,~ ..~y~ ......... .~.~ .................... . ,,.~o~ o~,o,~ ~,,~ Building Inspector. Rev. 6/30/80 FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapprove~r a/c ....... ~ 7- ........ ' .................. .................... -"::"':'" APPLICATION FOR BUILDING PERMIT Date )2_~ ~&~3 -t.~ ~C 19... 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 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 Regulations, for the construction of buildings, additions or alteratio, nsr4~for The applicant agrees to comply with all applicable laws, ordinanceS, build~ ( admit authorized inspectors on premises and in building for necessary~ (Signature I and other applicable Laws, Ordinances or ~,~Vho~empli~on, as herein described. ?de,~nd regulations, and to ............... ~cant, or name, if a corporation) State whether applicant is~ lessee, agent,~ngineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... (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 ......................... Electrician's License No. ~. ...... if ....... ~.'. ..... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section Block ...... --..- ........ Lot ......... 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 ~ O~ ~ ~ I h ~ ~ b. Intended use and occupancy ~'~~.... ~[ ~>~'~ 3. Nature of w..or,k (check which applicable): New Building .......... Addition .......... Alteration Repair .. :~-- ......... Removal ........ Demolition .... Other Work .... 4. kstimated Cost ....... t.'/d. 1 ............. Fe ..........'~.~ ~ (to be paid on filing this application) 5. If dwelhng, number~of dwelling !umts .............. Number of dwelling units on each floor ................ If garage, number of cars .... ~........~q~o-.~.'. ......................................................... 6. If bus~ness, commercial or mixed occupancy, specify natttre ,a~.d extent of each~type of use . ~ ........ ~ ...~,. ..... 7. Dimensions.of,ex.isting structurqs, if any: Front. .3C..~' l~i ... Rear . fr~.'.~.': ...... Depth .... '~..(".q' ... . Height ... l.r[ :..~. ....... Nun~ber of Stories ........... -2._. ...................... ' .... Dimensions of same structure with alterations or additions: Front . 3')?..c9..~..~.~' ..... Rear . .~.?..qa.~. ?,~ ...... Depth ~'~. Height Nu bet of Stories ' * I ...... 8. I)imen~sions of entire new construction: Front ....... --'. ....... Rear ....-2-~..9..-- ...... Depth ....... Height :-: Nuntber of Stories 9. Sizeoflot: Front ::: ~..fk.~.~.' .~: .R;~ :: .................... D~e,p, th ...................... 10. Date of Purchase. ,. Name of Former Owner ...<d.~. ~.W. '9.t46....c-~>l 11. Zone or use district in which premises are situated ..... ~..'.s;!©.~...'~..~..C ................ ; ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~. o 13. Will lot be regraded ...... .~ ~. .................. Will excess fill be removed from premises: Yes No 14, Name of Owner of premises ~. :i .~?.~..C44' L..~. ...... Address ~:'.~...~.~'.~Y.'..c?.~..1~... Phone No..'Z. fi.~. .~.? .4. Name of Architect ,.~. C>t~' ~//~tk Address o ,~ ~ Phone No. Name of Contractor Ii ~, ~ , ......... : ................. Address ................... Phone No... P .... .~ ....... 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 description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~YO, RK, ~ '° S COU ~)~ O~~,.~.. ..... ~' ..... · ~.~. · .~?.~. · .~...~ .... ! .................... being duly sworn, deposes and says that he is the applicant ~' (Name of individual sign!ng contract) above named. He is e ...................... ;. .C_~- (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to ?rform 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 .............. .... .... ' , / .OT^~ ~,u,~uc. s',,,,, o; .ow ¥o,, ~,~ ~ ' - ,,. ......... .-';... ·..: .................... e~i.~, I~,,~, ~,,,~ ~0, t,~f~ ~/~ (Signature of applicant)