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Home My WebLink About7233-zFOEM NO. ~ ?O~N OF $OU?~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISE COMPLETION OF THE WORK AUTHORIZED) N? 7233 Z UNTIL FULL Permission is hereby granted to: :~.t~ct~L~y. '%'L;Ls,s /,.~'. '~,~i;¢..e ..... ' .................. ............ ~:~. o ~. ,....1 .......... £~[..&~ ...... .................. ~,lattit~ck to erect side yard &botherfence ; at premises located at .......................................... : ..................................... . .B~I:~. 2}raT. A.~.~ L~urel ...(~la.~;k~e,~.....JL,..Q.,) ..................... pursuant to application d~ted ........................~ ............ ~...~....., 19.~..., and approved by the Building Inspector. TOWN OF SOUTHOLD TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. , proved ........................................ Disapproved a/~ APPLICATION FOR BUILDING PER~IT Date ..m....C INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in hk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according '~o schedule. b. Plot plan showing loca['ion of lot and of buildings on premises, relati6nship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn ~)n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance d. Upon approval of this application, the Building Inspector will ssue ¢ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the world. e. No building shall be occupied or used in whole or in part for any puCpose 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 o( a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New IYork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed The appliccnt agrees to comply with ail applicable laws, ordinances, buildihg code, housing code, and regulations and to admit authorize~ inspectors on premises and in. buildings for necessary n~spect ans. (Signatur~e c~applicant, or name, if a corporat on) ....... '~ddress of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, gener¢l contractor, electrician, plumber or builder. Name of of prem ses I~ ¢. owner ..................................... .~ ............ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Nome end 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. Mep Na.: l . . .~, i . .[, l~l./. ................... Lot No ....... ~.~ ........... I Street and Number~ { Municipali~ 2. State existing use and occupancy of premises and intended use and, occupancy of proposed construction: ........... b. Intended use and occupancy .................................................................................../~ --~ ....................................... property lines. Give street and block whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other WorkC~.~.~.?.~.~¢,.~.....~.O.~...~. ....... ~,~ ¢ (Description) 4. Estimated Cost ............................................................ 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 ....Z..c..o...~.. ................................................................................................. Dimensions of same structure with a.lterotions 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 ........ .~ ............................................. Rear ...... .:~'..O. ............................ Depth ...... ]..~. ....... : ........... 10. Date of Purchase ..~..~.~. ..................... Name of Fo_ mer Owner ....... 11. Zone or use district in whi' ch premises are situated ......... ~..~.....'.~....(~...I..~..~'..~ ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~...D ............................................. 13. Will lot be regraded' ....../~!...c;? ............. Will excess fill be removed from premises: ( ) Yes ~'/) No 14. Name of Owner of premises/~f..,Y./~..f..,S.,..~.,..E.J.~.~.$ ........ Address ....~.~4'Xt..~.. ........... Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from description according to deed, and show street names and indicate f STATE OF COUNTY oF~~ .......... ~.~..~.~.~:x.~.....~..LL.5.~ ................................................. being du y sworn, deposes end sQys that he is the epplicam (Neme of individue] signing contrecf) ebove n~med. ........... ............................... .................................................................................................... (Contractor, ~gent, corporete officer, etc.) of s~id owner or owners, ~nd is du[y ~uthorized to perform or h~ve performed the seid work ~nd to make ~nd file this epplication; that the work will be performed in the mQnner set fo~h in the ~pplication filed therewith. S om to this ~Signature of applicant) JUDITH T, No 57-O3,t4963 Suffolk Cou~