The URL can be used to link to this page

Home My WebLink About15092-Zr lr~LD I~,S~ ~C~I0 ~ FOUNDATION ( 1 st ) tiDATE tt FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION ?ER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: lt'O]~.~ NO. ~ 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) 15092 Z Permission is hereby granted to: .......... ............ ~...a~r,~A,....~:..~........l.~..~..~..?...: .... ,o .~........~........~~.....~..~.....~.. ~..,..~....~-~... Ot premises located at ....~.C~....~,.~ ....... .~...k~..,......~.~g.].~...~ ............ .~ .................. County Tax Mop No. 1000 Section ....... L.~..~. ........Block .......... ~.? ........Lot No.....~....~. ............. pursuant to application doted ........ ..~.~..~'] ......................... , 19.~l.J~., and approved by the Building inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 i ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN HALL ~ gOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined....~./..~..., 19~. ¢. ' ' .~. ~']..~..., 19~..~. Permit No. ! ~0 c)"l '~- Approved Disapproved a/c ..................................... ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ets 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 hall 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 .hall 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 tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ('he applicant agrees to comply with all applicable laws, ordinances, buil!;ling)code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary in.~e{~ ~s. ¥ ~ ....... Z~. ..-~.-. ..~'/. . . . ,..~. . .,.~. . . ~-.-~ , .... (Slgnatur'e of appl~ 'icant, or name, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. A ........................ .rid....9. ,~. ~._,((. .......................................................... Name of owner of premises... ~ .~'f~f. P'('a~~a't~t' ~e'd', ......................... 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 ....................... Othrr T,.d.', Lice,,~ No ................ ". ..... . Location of land on which proposed work will be done~ ~.. . ............................... Ho~e Number ; Street County Tax Map No. 1000 Section .............. Block Subdivision ..................................... Filed Map No ............... Lot ............... (Name) '. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... 0Ov~/I l~.~. ............... :"' ';' :7 '; ''~ :.': ': ................... ............ : .... .,.. ~. 'Natui'~ of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) Estimated Cost ..... " "!~..~../ dd.~. Fee · (to be paid on filing this application) · If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number or cars ..... ~...~.,E.... ~.~x(.... ~ ~'.~. ~.- ........ ~Q .......................... · If business, commercial or mixed occupancy, specify nature and extent of eg~h I~"~f u.s~ ..................... · Dimensions of existing structures, if any: Front ............... Rea~.~ .... ,%~,~%lOeul~.~. ............. Height .. Num bet o f Stories .,,,~'~.. Dimensions'of same structure with alterations or additions F~r~l~.?. ~.~..',.. _~.~,,..~,~.~....................~'~ ............ ...................... eight ............ .a LUaO · ' ' ' ' ' · ' ' ' · ' · · ' ' ' ' . Dimensions of entire new construction: Front .... / t~...~n~. ~e~'~.. ~.. ~'~. :~,,~epth . a~. ~ ......... Height .. · Number of Stories Size oflot: Front .... [..'~ .~ ............. Rear ...... ~~.~.~q~ Date of Purchase ............................. N~ame. o~) ~ ........................... Zone or use district in which premises are situated .... ~.<L/fi'4 ~l}il~.~,~ .~l~.. ~ ............................ Does proposed c,onstruction violate any zoning law, ordinance or relictionS. ....... /0~ ..................... Will lot be regrad~d ......... sP~.0 ..... '~.. ;~. .....Will excess~oe r,emoved from premises: Yes No Name of Architect ........... ?... b.~/~ ...... Address ................... Phone No ................ Name of Contractor ....... i ...... ~¢~f.-. ...... Address .... : .............. Phone No. x} ............ . Is this property located within 300 feet of 'a tidal wetland? *Yes ..... No .~.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prol ~osed, and. indicate all set-back dimensions from )perry lines. Give street a ~nor or coruer lot. ~ck number or descripti, ~n according t{. deed, and show street names and ~l~licate whether ~ ~ ~ILDING OEP~R~M~* AT ~ 7~.1~2 9 .~M TO 4 ~ ~R THE ~ FoLLOWiNG iNSPEC~D~S: 1 ~UND~tO~ ~O REQUIRED FOR ~UnED 2 ROUG~ ~R~M~G ~ ~uM~NG 3. INSI~A r~O~ 4. FINAL CON.RUCTION MUST . BE CO~LE~ FOR C.O. ~ T~ REQUIREMENTS OF ~ N.Y rE OF NF'~ Y9.~'~' ~S rNTY CIE/.~~ ..... ~" / __ " (Sg; ofindivi" ' -- ~ ,.. ,, --. --~t~l sign"' 'i~'contr' - 'lc'ti ..... e named. ..... being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) id owner or owners, and is duly authorized to perform or have performed the said work and to make and file tttis cation; that all statements contained in this application are true to the best of his knowledge and belief; and that the : will be performed in the manner set forth in the application filed therewith. 'n to before me this ........... '...day of .. ryPublic, .... ... C unty Se. ~7430~' ' -"Ik CountYrv (Signature of applicant) Cmnmisaion ~'