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Home My WebLink About7625-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7625 Z Permission is hereby granted to: ..... ~::~ ........ ~5.~."..~ ..................... at premises located at ............................................................................................................................ pursuant to application dated ~// /~/~)// 19...~..~.. and approved by the Building Inspector, Building Inspector FO~,,~I NO. 1 TOWN OF $OUTHO~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined J~'r'~ ~19 ..~..C./. .................................... 7s-; ....... ........... .................................................. (Buildin~ Inspector) Applicatien Na ................................. ~, APPLICATION FOR BUILDING PERMIT Date ................... ...................... , r 2..W ...... INSTRUCTIONS This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~,~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of iot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn On the diagram which is part of this application. 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 o 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in: buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Non'~e of owner of premlses ..... '.~ ..: r .......... ..)~.~.J .......... :~.,, ............ ~ ............................. If applicant is a corporate, signature of duly authorized officer.~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which reposed work will be done Mep No.: ........................................ Lot No P ' ~' ' ~' 'i' ....... ":'"'~( ..... Street and Number ................ 4..¢ ........ / .......... ¢.,/. .......................................................................... Ct ...... ~..~'~ ' · Mumc~pi~h~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy . , " "/ b. Intended use and occupancy ~ ' ~ ~ ~ 3. Nature of work (check which applicable): New Building .................. Addition ............... ]~ Alteration .................. Repair .................. Removal Dem61ition .................. .. Other Work ,~r ~,. ',,, (Des~l'iption) ~.urgt' ~ ) ~ / )', ~ 4. Estimated Cost ........... ;.....~..-:...': ...... ~ee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garaDe, number of ~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stories ................................................................................................................. Dimensions af same struct~r~ with alterations ~r q, dditions: Front .................................... Rear ............................ Depth ............................... D ~eight ................. .L...J'....Number of S~ories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... ~. S~ze of lot; Front ........................................................ Rear ............... L.;: ...................... Depth ........... ' ..................... ]0. Data o{ Purchase ........................................................ Nam, of Dormer ~ner ........................................................ 1 ]. Zon, or use district in which premis.s are situated ..................................................................................................... 12. Daas proposed construction violat~ any zoning law, ordinanc~ or regulation; ........................................................ 13. Wile lot be regraded . ........................... ,~WilJ excess/fill be removed from premises: ( )~Yes ",~] ) No 14. ~ome o{ Own*r o{ premises .~:(?~?72 ....... ~7{~ ~.X. ~.~ ......... Addross '~%...~ 2Z.~;).'~(.::L: ~hono ~o ....................... ~me of Architect .............................................................. Addro~ ................................ Phon~ ~o ....................... ~ome o{ Controctor ............................................................ Address ................................ Phone ~o ....................... PkOT DIAGRAM koc~to cleorly ond distinctly oll buildin~s~ whether existin~ or proposed, ond indi~to oll sot~ck dimensions from proper~ lines. Give streot *nd block number or description occordin~ to doed, ~nd show stroot n*mo~ and indic~to ~hothor intorior or cornor lot. STATE OF NEW/YOR~ ,///'~ t c ¢ COUNTY OF ;..:...i~X......: ............... .............................. ; .................................................................. being duty sworn, deposes and says that he is the applicant (Name of individual signing contract) a'bove named. He is the ~ ................ · ............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ta 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 of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to.before me this i ,,.. ~ t'~/ day of ....,~ .................., ........ , ........... , 19. ,' ........... ~'"~' ........ ~.,,,.:;.'.~.,~~.:. ......... t,.,.~:.....~...~ ....... ~.~un*' ·.-r~-~u ~y Notary Public JUDITll T, BOI(EN (Sigr~Sture of opplicant) Nol~ry Pu[~!ic, State of New York bio. 52-034~,963 Suffolk County ", Commission Expires March 30~ 19__ '