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Home My WebLink About7255-z FORM NO. ~g TOWN OF .SOUI'HOLD BUILDING DEPARTMENT TOWN CLERK'~ OFFICE SOUTHOLD, I~. Y. BUILDING PEBMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) N? 7255 Z Permission is hereby granted to: ¢le~ent & Y~rgaret ~o~:~' .............. f~Q.....s~n~..~e .............................. ................ J~L.t, tca~ ......... IL.Y;. ......... : ............ to Jt zaJe [bLLL~Ld~ug ........................... i ................................. i at premises located at ....~/.~...~...~..~.~.~.$.~.....?..~.~.ljL...~].q~)~ .................................... .................................................... ~I:~.~I~.~Q~.~.....~( ~ ~.~ ........................................................................ pursuant to application dated ................... 14aJ~.....$Jl, ................... , 19~J~,., and approved by the Building Inspector. Fee $ J..O..t...O~... ........... Building Inspector / TOWN CLJF, K'S Or'FleE SOUTHOLD, N. Y. APPLIC:ATION FOR BUILDING II~RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter aC. in ink and submitted in triplicate Inspector, with 3 sm of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and df buildings on premises, relationship to adjoining premises or · areas, and giving a deta~ed description of layout ofpraperty must be drawn on the diagram which i$ part of ~ ~ _ 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 Permit to the applicant. Such 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 Occupant, 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 appllc.able Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolltmn, 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. (Signature of apphcant, or na/i~/if a corporation) ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~r (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Name of owner of premises ....... g~Le~e, lxt~..A..lla~....l~tmg~.e.lL.l~....~o~J:£. .................................................................. If applicant is a corporate, signature of duly authorized officer. ~ 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 ~.~..~.~.5.~j?~.~..~.~'~.g~..G~.#~1:.~.~.~.~(~1~1~~8.) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and,occupancy ...... ~....e..o..~.t;...it.~.e, .......................................................................................... b. Intended use and occupancy ........... J~JJJ~ ................................................................................ Nature of work (check which applicable): New Building ..~T~r~ ........ Addition .................. AIh Repair .................. Removal .................. Demdlition ................... Other Work ....................... (D 4. Estimated Cost ..... ~j~ ........................................... Fee ..... I~1. ...... 5. If dwelling, number of dwelling units ~ .................. Number of dwe lng units on each flo~ If garage, number of c. ors : ................... ' ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~ 7. Dimensions of existing structures, if any: Front ..........~'1' ........... Rear ......... ~4 ................ De Height .~.# ........... Number of Stories "13~1 ......................................................................... Dimensions of some structure with alterations or additions: Front .................................... Rea Depth ............................... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~{)~ ......... ;. ............. Rear ..... ~O'e ............... D~ Height ..f~ ............Number of Stories ........ Ir. ........................................................................... 9. Size of lot: Front ..... ~.! .......................................... Rear ...... ~,4~.~ ........................... Depth 10. Date of Purchase ..~:.~e..~ ........................... Nome of Former Owner 11. Zone or use district in which premises are situated ......... ~'.~U~.~JI~..~ .................................. 12. Does proposed construction violate any zoning Iow, o~dinonce or regulation: ............ ~ ....... ~ill lot b~ regroded ....... I~ ............... Will excess fill be removed ~r~ premises: ( ) Yes 4. Nome of Owner of premises ..~).l~3,l~..~.~***Mo.~le~ ........... Aodress ....................... Nome of Architect .............................................................. Address ................................ Phor Nome of Contractor ............................................................ Address ................................ Phor Locate clearly and distinctly all buildings, whether properly lines. Give street and block number or descriptio whether interior or comer lot. . ^~. -~. 10' x 10~ ot~el 8to~age ~d witheu$ utiXlties \ ,g~t~o d~md show STATE OF NEW YORK, ~ S S COUNTY OF .............. (N~Yv~;~I ~gr~ilng c~racf) above named, v- { f¥, duly sworn, deposes and says th rotion .................. ~scription) ication) ~th ...~! ........... ( )No NO~..~...O~O~.. dimensions from and indicate ~ He is the ' - .................................................. (Contractor, agent, corpo(ate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ar d to make and file this opp ication; that a statements contained n th s application are true to the best of his knowl edge and belief; and tha~ the work will be performed in the manner set forth in the oppl co{' on filed therewith. Swam to before me this ' ........................ day of ............................................ , 19 ........ he is the applicant (Signature of applica Notary Public, .................................................... County mt)