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Home My WebLink About7017-z FOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJ~PLETION OF THE WORK AUTHORIZED) No. 7017 Z Permission is hereby granted to: 't-tut ~v I'-~t~ F~ r~c 1:7 at premises located at /~//~ / ~ 'F~ c ~ ~_~ pum~nt to a~lication d~ ............................................. .~ ........ , 1~.., and approv~ by the Buildi~ Ink,tot. ..... Building Inspector /! Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ..................... ~..~ ........................................ .......................................................................... ...... (Building Inspector) TOWN OF SOUT OU> _ BUlI.DIN~ DEI~AlrrMEN"r ),z¢¢ ~-~- tv,. ~-,~ ~ t,.~.-c-~- TOWN CLERK'S OFFICE ~' SOUTHOLD, N. y..,~ /¢'~'~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely f!lled in by typewriter o¢ in ink and submitted in triplicate to the Building~t 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 relat onsh p to adjoining premises or public streets o~ areas, and g v ng a detailed description of layout ofpraperty must be drawn on the diagram which is part of this applicatJon.-~ 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 issue 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 pa rt 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 cor~truction of buildings, additions or alterations, or for removal or demolition, as herein described. eTch, me pppli.cant ag. rees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to it authorizea inspectors on premises and in buildings for necessary inspections. '.,.....,2.. .................................. t~gnarureqCf:aPl~rcan¢, ~if a corporation) , .................... State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. If opl~lic~t i~o corpo~Ke~/~nature of duly aumor'ized officer. 0, T Z.- Y3 ,'/,z/?,~ (Nominal tit · o~ corporate officer/ Builder's Liconse 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. Mop No.: ................................ Lot No ..................... ·' ' .... Street and Number .... ~'"'"~'?" '~'t .... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ""' b. Inten,ded use and occupancy ......................................................... 3. 'Nature of work (check whJcJ~ applicable): New Buil~Jing-...~ .............. Addition ......... ~ .... Alteration .........: ...... Repair .~ ............... Removal .................. Demolition .................... Other Work ...... ..~..~..." .................. 4. Estimated Cost ~ ~)-~')* (~ ~... ......... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling uni.ts ,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 Dimensions of existj/~g structures, if an~. Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ..................................................... ? ......... ~ ................................................. Dimensions of same structur~ with alterations or additions: Front .................................... Rear ............................ Depth ................ ~ ............... /Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Hetght .................... Number ~o:~ ~.t~ries .............................................. : ....... -, ............................... .~...--=.a .......... Size of lot' Froot .....~...~..~'~ ...... i.i. ............. Rear ............ ..i~.~.3. .................... Depth .....~.~ ................. '0~ .D~teof Purchase ....... ;..- ................. ; ............................ Name of Form~e~ ~n~er/'~......(~..../....O....'?....~T.!....~t.. ............ 1 1. Zone or use district in which premises are situ~ated ................ ~ .................................................................................... · 12. Does proposed construction violate any zoning law. ordinance or regulation: ........................................................ ~31; ~il[ ~etJ~e::~egrede~.'.....; ...... ~_....'..'.q...,~,~Wil~gxces~/~ill. be remove,.cl fr~o~j~r~l~.s~5~(. ) Yes ( ) No 14. Nome of Uwne. r ef premise~:':: ......................... ~aaress ·--' - . Name o~ Architect .............................................................. Address .................. ~ ........Phone No ....................... Name of Coqtmctor .......................................................... Address ................................ Phone No ....................... LOCate cl~dHy 'and dJsti~ ~11 set-b<:ck dime,s!OhS from Show street names.a~d indicate STATE OF N~' COUNW OF ........................... ~.~..,~....~..;..~,~....4 ....... being duly sworn, d~oses and says t~t he is the applicant (Nam~ ~ ~ividu~ignin~ contmc~ ' above nam~; He is the ......... ~"~ (ContraCtor, agent, co~orate officer, etc.) of said owne~ or ~ners, and is duly auth0Hzed to perform or have performed the said work and to ~ke and~ file this application~ that all sta~ments contained in this application am tree to the ~st of his knowledge and belief; and f~a~ th~ wore wdl ~e performed ip the Manner set f0Hh in the &pplication filed ther~ith. S~m to ~re me this '/ ...... , ....... .................................... · ,*~" ' (Sigfioture 0f applicant) _ JUDITH T. BOKEN Nofary Public. State of New York No. 52· 3344963 Suffolk Coun y Commission Expires Marcl~ 30, 19._~/~