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Home My WebLink About7643-z FO~ ~0. 2 TO~N OF SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7643 Z Date .~.OV. 26 19~.,~, .... Permission is hereby gra~ecl to: John b. ~o~ci~e .......... ~a~... ~,~m.~,..?. ~.a.,...~l~.. }3,1~L ........... ....... LaYm~.l.. .~:~.~.I,. ................. to .~a:c. cc.t...~.~.t~ ..=~a~:...l~a~d...£~a¢&ra~. ........... . ............... ~t pmmi~ I~t~ ~ ..~.~.9.~...~..~ .q,. ~.~..~&~. ....... Laur~l pumuant to ~lk~fion d~t~ .................................. .x ............ .~.., 19.~.., ~nd ~pprov~ by the ........ r-l' ........... ;;":;';:'"'",'""""~';; ............. )t. ........... om,ding inspector / FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ..................... , 19.. Application No. '7 ~ (/~.~ * proved " " " Z xY' ........................................ , It ........ Permit Na ................................... Disapproved a/c ...........7.~ ........... ~' Z:Z~ .............. ~'""'~=~'~ (Bui ding inspector)/ .................... " APPLICATION FOP. BUILDING PEP.MIt Date ~d c~L( 192c~r. INSTRUCTIONS a. 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 bui dings on prem ses, relat onsh n to ad~oinin ..... ~ .... g v ng a deteded description of layout ofproperty must be drawn on the diagram which is part of th s 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 a Building Perm t 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. ................. ~ (S'gnature of applicant, or name, if ';";;';1~'~)';;'~ ;~'i ........ ................ ,~...~... j.. 4 .~ .~. ....... ~..;.././. [., ,~.. ,~,', ,~,., ,'v~?/..t/, ,~, ~ .~,z~,, ................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: (Name end 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 propose, d work will be done. Me~,N~.: .................. ..~...... Lot No ~ Street and Number .~..~'..'.~..o.....f.~....qVd..~....~rc~.t.., .~...~.¢...~..,..~.~. ............. ' ........................ Municipali~ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................. Repair .................. Removal Demolition; .................... Other Work .. // (Description) 4. Estimated Cost ....'.71.~:.~ ........................................... Fee /~-~--- (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units 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 existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........... .J-.~..Q. ..................................... Rear ........ Lr4...O.. ........................... Depth ..... J:'fl....~. ................. 10. Date of Purchase ........................................................Name of Former Owner .~....T..~ .~..~ ......... 11. ~Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ................................................. 13. Will lot be regraded. ........................... Will excess fiji be removed from premises: ( ) Yes ( ) No Name of Owner of prem,ses .......... Address Phone Name m-- Architect ............//? ............................................... ~ddress ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly an8 distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ................................ duly swom~ deposes ~nd soys that he is the ~pplicom He is the .......................... ~ ................................................................................................................................................ (Contractor, o~ent, corporoto officer, otc.) of said owner or owners, ond is duly outhorized to perform or h~ve performed the s~id work ~nd to m~ke ~nd file this opplic~tion~ that ~[I stotsments contoined in this application ~re true to the best of his knowledge and belie~; thor the work will be per{ormod in the manner set fo~h in the opplicotion flied thorowith. Sworn to before mo this 19~' ............. ~..~. ~o~ o, ........ ~~.~ ......... ,.~ ..... D ?) ~ ~ . .......................... Nota~ Public, ~ ........... J (Signature of applicant) -