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Home My WebLink About7380-z FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFIGEi SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) ; N°. ' 7380 Z Date ............ ............. ,,Z.U.t.y .......... .~ ........ , 19...~)+. Permission is hereby granted to: ....... .~m~..gar~:~ll ....................... :, .................. ....... ~ g.....~.a.~.~en.. ~.~ ..................... .......... 0,¢~ an,~.~.~, ............................................... toerect and .~.~l.~L~,~..,~.~t~..~.~:~...~.¢.e .~2.:2. h ~h .................................................... at premises located at ~/.~ ~g.'blg~ tl~D~. ,~{.Oa~ ;. ................. ....................................................... $.outho. l~..I~.,~.~ .......................................................................... pursuant to application dated ...................... .~.1~. .......... ~..;....~....., ig.~...~.~i.,~and approved by the Building Inspector. Fee $.1 ~.,~.0.~ ........... ~ ~T '~ii Building InSl~Ct'or ~k NO. ! TOWN OF SOUTHOLDi BUILDING DEPART/~EI~ TOWN CLERK'S 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 plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relat onship to adjoining premises or public streets oF areas, and giving a detailed description of layout ofproperty must be dr~wn on the diagram which is part of this application. c. The work covered by this application may not be commenced befoFe issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issueia Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wo~k. e. No building shall be occupied or used in whole or in part for any p~rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Newj York, and Other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ifor removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, Ordinances, b,uil~ing code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for neces~/cl/y__ _ ~./~.~)~'~" - .~~''' inspections. //~f~ .......~..~ -~. ~~-~i~notdr~'''~'x~''~-~ o~r"~'am'~:"i~"~"~';';l~';';~;i~'~ ........ ................. . ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................................................ .! ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of Tate officer) Builder's License No ..................................................... Plumber's License No. v'/ Electrician's License No ..... ~ ................................. Other Zrade's License No ........ ~i~. i ........................ 1. Locationof andonwhichj;~oposedw,~rkw~ll bedone Ma~ N~ ~. Street and Number ...... ~...~.~.i..~-...~.~ii.~[i[iiiiii.i[iiiii~~'i[il[[[jilj~ Municipality 2. State existing use and occupancy of premiss7 and intended use an,~l occupancy of proposed construction: bO' Exisitingntended uSeuse andand occupanCYoccu ant ............ ~'"~~'"~"/¢-~....~'~.~.~~ ............................................ "' Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ .... 4. Estimated Cost ............... m0 ........................................ 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 ...................................................................................................................... Size of lot: Front ............. ~../...~., ................................. Rear ..... ~.~. ...................... ~ ..... Depth ....... .~..i~. .............. 9. Date of Purchase ........ ~"'/,~L(~.../....~.~.. .......................... Name of Former Owner ..... -- .. -- .~ /~Z~//,],/~,~..~.......~,.~/j,~' ......... 10. 1 I. Zone or use district in which I~remises are situated .......................................... ..L~..-; ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded .................. ~.. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Nome of Architect ......................... ..~.. ................................ Address ................................ Phone No ....................... Name of Contractor .....................V .................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. " /z/I1. STATE ................ "(('~,i~ .~-.o~f individuol signing ¢ontrocf) ~bove nora d~-.~ (Controctor, ogent, corporoto officer~ etc.) of sold owner or owners, end is duly outhorized to perform or hove performed the said work end to moke and file this opplication; thor oll statements contained in this opplication are~ue to the best~m~s knowledge end belief~ tha~ the work will be performgcl~jn thep~nonner set forth in the applic,c~fior;/ filed there~Vrth. Sworn to before~.~is k ~ / / · / / / .- / ' ............. .do of ...... .............. . ( /.. /Z" otar ................ .......... /. ........... ..................................... ~ / // ~"-~ignature of applicant)