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Home My WebLink About13661-z · FORM NO. t TOWN O~ SOUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13661 Z Do,o ~ ........ .~..~... ......... , ,9.~..5.~- ...... ~ ~...~.:Y........./..~.~...~/ . ~ ~. ~ ~/ ~ ,~ /f ~ ~. ~ ~ ~; ~ ............... at premr~s I~ated at ....~ ....... ~~-~...,~ ......................... ............................................................... .... c~ ,~ u~ ~o. ~o0o so~,o~ .... ~.~.Z ..... ~k ...... ~.~..~ to~ ~o..~ ......... Building Inspector. Fee $.../..~... Rev. 6/30/80 FIELD I~ S P E~T I ON FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROBGH FRAME & PLUMBING INSULATION FER N. Y. STATE ENERGY G~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~. ~OUTHOLD, N.Y. 11971 BLDG. DEPT. TEL.: 765-180:3 TOWN OF SOUTHOLD ..... Disappro~d a/c ........ : .... ;~ ......... ~.. ................................ :: .... (Building 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 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, bu~ld'_mg code, hi,using code, and regulations, and to admit authorized inspectors on premises and in building for necess~ in~C6~9~ v - (Signfi~ture bf applicant, or name, if a corpo?ation) · .go:..~,,x./~.0 ..... .s.:.~.,,/~...,.~y.. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.,,,,,,','~ ~'~.,'*~..'Ow. .................................................................. Name of owner of premises ... b~l.e'~....00. ~/.(1'.*o~..g.-..~..~.n.I..~. ............................................ (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 ....................... Other ~rade's License No .... ~..~..~. ............ 1. Location of land on which proposed work will be done .................................................. ... o!.,,o,~ .................... ~.~ ¢.1~,,.,~. ~t:., ............. ~ .o~,~./.~. ........................ House Number Street Hamlet County TaxMap No. 1000 Section · . ..~..~-~.~. :~. ....... Block ...... J~...~.~ ~ . ...~5~Lot.~..~./~Z ............. 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 ... ~--~.fl, ............................................................ b. Intended use and occupancy . . ~..~-~ ...... ~x~~ ........................................ 3. Nature of work (check which a )plicable): New Building ..... I..'... Addition .......... Alteration .......... Repair ........... Reft.oval .............. Demol~tio~n .............. Other Work....K'¢~¢~. ....... 4. Estimated Cost..~.61~ ....... .......................... Fee .~7'~.q' .................................. i *', (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling Units 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 Dimefis'onsof ' ' gstructur~ 'fany: Fr nt Re Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ............ Rear ....................... Depth ...................... 10 Date of Purchase . Name of Former Owner 11. Zone or use district in which pr~mises are situated..~-~% ............................................... 12. Does proposed construction vmlate any zoning law, ordinance or regulation: .~. ............................ 13. Will lot be regmded ... ~.~>.. I ...... '- ............ Will excess fill be removed from premises: Yes No Name of Architect ......... .................. Address .................. .~Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OFNEW YORK, 'S.S COUNTY OF ................. ............ · ~/~q ~.~.. ~., ~"-'-'~.~..~. · ................. being duly sworn, deposes and says that he is the applicant ~'(Name of individual signing contract) above named. He is the ...... .~.~..~..~.e~.....i ................................................................... : (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 ofh work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... , .............. day ...... ......... NOlan/PtJItLtC, State NOL 4707818. Suftol~ Coootm ~ ' ~ .......... lerm Exp,~s ~.,ch