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. ; FOB,M NO. 2 TOWN OF S011THO�u , . �111LDING DEPARTMENT TOVVN HALL �� � � • SOUTH'�LD, Pl�. Y. - I'��.iv�.���� BUILDING P�ER0IAIT , � � v��" � ���� L� ����J (THIS PERMIT MUST BE KEPT ON TH,E P17EMISES UNTIL FULL a� �� CO�MPLETION OF THE WORK AUTHORIZED) 1.91� 115 7� Z Date ...�Y..:.�?:��.1..�........1.�......... ., 19..�� Permission is hereby granted to: ........G�.c��:/..:�.. ./...`.�......�=:�../.,�i..�:'.�, - . � � ....�...�...�:5�:�-��:r.�.....:��.-..:.......................... ...../..�.'�,�:'��.��.:.�.�.J........�.. .�......... � . ro .........'�..�..,,r„�,v-.:�.�`.��...G.:?.:.....�..��...C:'.��c-;�sc�'.::. . ......�:'���l:��1......c:.....�c.��.�c���� � c� .,� - ................................................................................................................................................................ ot premises located at .....��C^/.✓..��:.......l�. ./.��1.�.L�.o�.G�✓.....�.�:...................................... ................................................................................ ................... .��G:-`?�l../.. ....G:G��.--:��...:.,/, / ................................................................................................................................................................. County Tax Map No. 1000 Section ..�..�.J. �........ Block ....�?.�....... Lot No. .1:.�.-�.C�.�.�... �� / / pursuanY to application dared ......���C:I"�1......,�.��........, 19..��and approved by the Building Inspector. � Fee $...f..Y...�......... ��' `', � % r r /� , � - ....� .�,�:�I �C�..P.,...��.'.-G..��-�.�.�'..�:._..y,.. �uilding Inspector Rev. 6/30/80 - � - � FIELD �NSP�CTION DATE COMMENTS ' - rd ., 1 . �' � LL � �1 H� H ccc���,,, FOUNDATION ( 1 s t ) L�� � ,�� -- — — — -, ____ -- � � �� . � Cn R FOUNDATION � ( 2nd ) ' �� 2 . . � 0 \` ROUGH FRAME & � PLUMBING � . �� � - zn �, H ,� 3 . _ _ � � � INSULATION PER N . Y. _ ' y � STATE ENERGY �ODE � x . � r � . � 4 . y i FINAL - � ��-�e..� �-e.M. �- , ( �-� � � ��z�p�1 ADDITIONAL COMMENTS : � � . � _ - . �1 i � �� , x b �H - � '`c � \H H �O . � l-" - ' .� - � x � , � • • r H x .� � . � • . H ' ' •- , � i � _ . . ► - = - _ � . - _� � . i ' °` � F-� -�-i G ' -� � � � � � - � 1� � ��� C� ,�� 5 . � _ .-� � � � v� �-�-- � _ , � ' �� ��� �� � � b r i �jC � ��ri�i ��= c-�� o . � � � � �� ����v �z �- � � � i � i L-� w�� �j �F1s P��L--� s�-��,�.,:L� i . . . � � , , . _ . , � � , . ; � � _ � . � . � � , . . � � . �����i�. jc. � � Foa�n� xo. i � TObVMi OF SOUTHOLD . BUILDlNG DEP,�RTAAEPIT TOWN CLERK`S OFFICE SOUTHOI�D, 6d. Y. Exomined ���'�l� l �9 �� //� pc .................................7...., ........ APPlication No. ...........�.4.............. APProved ...../�..�..�..��41::....�.7.. ., 19�.�. Permit No. ,/�.�...�r...�...... Disapproveda/c ............................................. .......:.................................... -` � ......... .................. .. G�'.�'����......�......�.......................` / EBuilding Inspector) APPLICATBOtd FOR �UILDBNG P@RMIT � Date ..................�..::..�..�.�............. ., 19..�.�.. INSTRUCTIONS a. This application must be completely filled in by typewriter or. in ink and submitted .in triplicote to the �uild'o�g Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIoY plan showing locafiiorr of Iot and of buildings on premises, relotionship to adjoining premises or public streets �r oreas, ai�d giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this appliCatio�. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opproval of this application, the Building InspecYor will issue o Building Perrnit to the applicant. Such pe�rr�it 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 whotever until a Certificate of Oceu��ti�u�-y shall have been granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant tc� fhe Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other applicable Laws, Ordinance� or Regulations, for the construction of buildings, additions or a�terations, or for removal or demolition, as herein descr�bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and #o admit outhorized inspectors on premises and irr buildings for necessary inspections. ....c��. .. .............. � ..........:........ ....... . . .. .. ...... .... (Signature of ap�li ont, or name, if a corporatio�) .�.��s....�'��� ��:�:' .... .:..�..........a.......� (Address of applicont) State whe±her ap�licant is owner, lessee, agent, architecY, engineer, general contraGtor, elecfrician, plumber or b�asld�!r. ,...........�.4,.�.?�:��`..�...................................................................................................................................................�.....�.. Name of owner of premises .......����.6`��.....�&�..:�.........��:.:...��. �.�.�.�.��:............. _ ............................................... If opplicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate officer) s . Builder's License No. ..... ....1..!��:4E.'�......�5...�-�. ..�`.�t, Plumber's License No. ................................................ Electrician's License No. ............................................ Other Trade's License No. .............................................. S u b d i v i s i o n 1. Location of land on which proposed work will be done. Nti�p No.: ........................................ Lot No . .... ............ , ./.. Strect and Number .�.............................�.1.�5.�(!l...r.�.!-v....�v' �c91 !l��l�,�........... ..��.... ` ......................................... INlunicipality 2. State existing use and occupancy of premises and in�ended use and occuponcy of proposed construcYion: a. Exisiting use and occupancy ....�?'..�'.�.�.......��}k+�a��.....�?�.�.l,�,C,,t�c'�.......................................................... � �,a�l: � a'4'� �.�-C`��2 ��`'��.�jC� b. Intended use and occupancy ........... ....................... . ..... . ..................�.............. ........................................... County Tax Map No . Dist . 1000 Section CS` Block_�_Lot /, OC�� � .� ,,�,7 . :i''."� � � . . � __'' ` ' _ . 3. Nature of work (check which applicable): New Building• ...��j.... Addition .................. Alterotion ............,. . . Repoir .................. Removal .................. Demolitior,....... ....... Other Work ........................................ ....... , . (Description) 4. Estimated Cost ....�..r.�..�?C�.........................................Fe ......�.� .c'�.�.............. .. ..... . ......................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ....-,,,,.,,.,.,.,.,.,,,,.,. Ifgaraga, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of eQch type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... b Height ........................ Number of Stories ..i.............................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .......�.:�......�........... Reor ....y... ...��. ... .......... Depth ..��..�•..... Height ...�....�.°.:.. Number of Stories .......r............................................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth .............................�.. 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or usa district in which premises are situoted ..........1'8............:........................................................................... 12. Does proposed construction violate ony zoning law, ordinance or regulation: ........................................................ ]3. Will lot be regraded ............................ Will excess fill be removed from premises: ( )�(�s ( ) No 14. Name of Owner of premises�..�`�..1&��..�.k�:..�.�'.�.�:1:�.����. Address �ch.��..� .. '�.�..... Phone N��.�S:��.�,.�-:s Name oi= Architect .............................................................. Address ................................�Phon� No. ' ...................... Name of Controctor ............................................................ Address ................................ Phone No. ...........o...o.eo... �- PLOT DIAGRAM , Locate clearly and distinctly all buildings, whetner existing or proposed, and indicate all set-back dimensions froET! - property lines. Give street and blocic number or description according Yo deed, and show street nomes and inc�icate �vhether interior or corner lot. � �--�--�.=--�� _. STAT� OF N EW Y-R f t S.S COUNTY OF .. ... . .. . .. . . .. ...j .................................................................................................being duly sworn, deposes and soys that he is tne applicant ': (Name of individual signing contract') above named. � Heis the .................................:............. ............................................................................................................................. (Contractor, ogent, corporote officer, etc.) of soid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; �hat all stat;ements contained in this applicotion are true to the best of his knowledge and belief; and thar the work will be performed in the manner set forirh in the application filed therewith. Sworn to fore me this �/-� � � ......,� �....... d y of .��.�..�...... , 19.�c�—,'' � Notary Publi � . . .�s. . . .. -nty `•� .....................ly�..�. .�. .... ��........................ nto�an. �=���� -, �' (Si�nature of�a '�licant) ��o ��'..:� ,. �, _ - =; � � �-J�'i rt^ f r.:;' �o�flm;s�;o7 �"3 �:.:-^v;. ' '��:'. ' Fx • Co:.�n,,/ �;,��l,a2r�h�p, 19���� . :,—�.�\ _ - ' � - - , - _ � ,�y. , . e. ,:�� � +'y� -� `a �i 'r,, , � :r�;.h:n. 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