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Home My WebLink About13705-z FOB~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) No 13705 Z Permission is hereby granted to: ~ ~, ~ / ~o ............. ~~/~ ....... ~...¢~ ...... ~~:....~(~ ...................... c~,~, Ta,, Ma,, No. ~000 Seat,on ..~..~ .......... B~ ...... ~ ............ Lo, ~o ..... /.,...~.~... ..... pursuant to application dated ...... ~.-~¢~.~... ............ ~......~. .......... , ,9~and approved by the Building Inspector. Fee $..4.~.[Z..~.. Building Inspector Rev. 6/30/80 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approve ~.~. ~g~,, .[ 5.7 .... 19~...~Permit No./.ff. '/?..O. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application'must be completely filled ha 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 fidm Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Bu' ' g .... ' r r demolition, as herein described ulations for the construction of bu,ldmgs, add,t~ons or alteratmns, or fo ~ . ' ~ge 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... , 'i i ye-iLl ..................... Name of owner of premises '~.~.l.~..~, ................... . ..... ' (as on the tax roll or latest deed) If applicant is a corporation, signatm'e of duly authorized officer. (Name and title of corpor&te o~f~cer) Builder' 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 .....................: ............................ . q v. 3 .v. . . . . . . J.v. x . . ., ./, .............. House Number Street ]~/am let County Tax Map No. 1000 Section . · · ~. ~...~ ......... Block .................. Lot .................. Subdivision ................................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and °ccupancy °f pr°p°sed c°nstructi°n: ...... a. Existing use and occupancy .................................................... ............................. b. Intended use and occupancy .... ' ........ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............. ~ .... , ......... Damolition ............... ' Other Work ............. f/ ~ ~ r'.~.~e.~ ~ .~ (Description) Estimated Cost ~'., 4. .. ,y ..................... ee ...... ~...~/ ......................... i' *" (to be paid on t~ling this application) 5. If dwelling, number of dwelling! units ......... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 6. If business, commercial or mixed occupancy, specify, nature and extent of each typ. e~ of.use ............. ,, .... ,... (~) Dimensions of existing structures, if any: Front...~. 9..-~..eq_~.~ .... Rear . .].~. ~g,e~..." Depth ~ 0 ~e-e..~. Height Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... j... Height ...................... N~mber of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Former Owner .......................... 2 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will regraded . :~. 14. Name Of Owner of premise~.~e~'g. ~...~...... Address .. ~ ................ Phone No ................ Name of Architect ......... .................. Address ................... Phone No ................ Nmne of Contractor .......................... Address ................... Phone No ................ Locate clearly and distinctly al property lines. Give street and bloc~ interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back .dimensions from number or description accordihg to deed, and show street names and indicate whether /,¢ ¢r i,5' STATE OF NEW YORK, I S.S , COUNTY OF ................. ................................................' being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the ..... ' t i (Contrac r, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to p application; that all statements con~ained in this appli work will be performed in the manner set forth in the a Sworn to before me this ............. /.3... ~.,. .... day o~...~, eg-~-~.....'. Notaw Public ...... ~,c¢..~. HEI.EN I~ ~E VOE ~,IOI,~RY PUBLIC, State ol New~ No 4707878, Suffolk Cotlilly [em, Expires Mart:l~ 30, 19~- ~rform or have performed the said work and to make and file this :ation are true to the best of his knowledge and belief; and that the Cplication filed therewith. · County t)