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Home My WebLink About7202-zTOWN OF sOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS COMPLETION OF THE WORK AUTHORIZED) N? 7202 Z !S UNTIL FULL Permission is hereby granted to: ~.o..v.~..4 ..kL.....~.e..~ ~z .......................... . ................. .............. seu-~h~l.~ ............................................... to ~ r~.k and.. ~int~in.....~r...¥ar~ ...(.tem~ or. az~)/ga~.~an., f. ene e...& ..futu-~.e ....... ..... ~'4e~..a~ct~.s~de..~a~4,-.£~n~e-...¢a~..~edge')..-~"$~;"i~;~ ......................... ~. ......... at premises located at ....~,/.S..ffl:~r~)~..~'~ek. J~.~.~s ........ ~ .......................................................... ........................................ : ........... ~t~tho&c% ........ ~.I. ............................. ......................................... 19~:...., and approved by the pursuant to application dated .......................... APl~.l] ........ ~-~.-...., Building Inspector. Fee $.1 .~.s.QO ............ Building' Inspector Approved ........................................ , FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TO~WN CLERK'S OFFICi~ SOUTHOLD, N. Y. Perm,t ..... Application No ................................ (Budding Inspector) APPLICATION FOR BUILDING ~'I~RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according ho schedule, b. Plot plan showing location of lot and of buildings on premises re!atibnship to adjoining premises or public streets o, areas, and giving a detailed description of layout ofproperty must be drawn !on the diaCj'ram which is part of this application. c. The work covered by this application may not be commenced befode issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue]e Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wor,k. 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 thel,issuonce of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, NewlYork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, bu Id[ng code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary idspections. (Signature of applicant, or nam,~if a corporation) Southbld / (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owne~. ........................ i ........................................................................... Name of owner of premises ...... ~.QWf~.E0...,~.~,~,,~?~ ................................................................................................................. If applicant is o 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 ............................................... 1. Location of land on which proposed work will be done. Map No.: ~:;~"~ ........................ .... ~ ................................... Lot No. ~ Street and Number .................. o'[.oc~e.~..C~.e~i...~l~.~.ta ............. ~,t~t.O~:~ ...................................................... Municipality 2_. State ex sting use and occupancy of premises and intended use an~ occupancy of proposed construction: o. Exisiting use and occupancy ...~?~.e..1...]:.J....~.g .......................................................................................................... b. Intended use and occupancy ........ fi~ ........~.,.~.f~.~,:~...~.~: :~,..[~.~.~.~...~.f~,g..~ ....................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ....~..e.~o..J..~.~. ................................ (Description) 4. Estimated Cost ..................... :l.D.O...~. ........................... Fee ..Ji~.,.QQ. ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .'1 ............... Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 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 ..... ,q. 20 ............................................ Rear .......................................... Depth ......~0 .................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....!~..~.!!....~.$..S..~. .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ..tg...O. ............................................ 13. Will lot be regraded' . ........ ~.O .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .....~.QW~.~.~...~.e.:R~'~. .................. Address ........ ~..o..~...~..~..o..~.8.. ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor saree ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oH 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. STATE OF NEW~¥QRL~.., ~ c c ...................... ~[O~.aZ'.cl...Tfl~.~'. ............................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all staternents 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 / / ~' ' ~ t (Signature or applicant) / JUDITH T. BOKEN Notary Publrc, Sla/e of New ~ork