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Home My WebLink About7307-z lrOB~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7307 Z Permission is hereby granted to: .iJob~..Barae~t ............................................. ~ ........ ...~,~..~4 .................................................. ~o ....~n~t&1~..pr.~..u`r*~.'~w~.nn.tr~..p`~0..1...v~t.k~.`au~..&..~es.t~.'.~a ........................ at premises located at ...JJJ.8..JJI~A.~ ................ ~...i., .................................................................. pursuant 'to application dated ......................... ~.~lJ~,....~. ............. , 19..~Jf.., and aPproved by the Building Inspector. Fee $.4.~.00 .......... / :/~ ,/'Z4,- ....................... APPLICATION FOR BUILDING PERMIT a. This application, must be completely ~filted in by by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sm ofplons, accurate plae plan to scale. Fee according to schedule. b. Plot plan showing lecatior~ of lot and of buildings on premises, relationship to adjoining prem ses or pub ic streets o~-~ areas, and giving a detailed descripti°n of !ayout,o_fproperty must be drawn on the diagram which is part of this 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 o Building Permit 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 at ~egulati.o. ns, for the construction of buildings, additions or alterations, or for removal or demolition, as herei.n described. ~ ne applicant agrees to comply with all applicable k~s, ordinormes, building code, housing code, and regulahons, and to admit authorized inspectors on premises and In buildings for necessary Inspections. (Signature of applicant, or nome, if,a corporation) (Address or applicant) (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. 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. Electrician's License No ............................................. Other Trade's License No ............................................... 1. LOCation of land on which proposed work will ~ done._ M~3 No.: ................ Lot No ......................... Street and Number ........................... ~.....~.....~..~c~'~ t/ '~'_:'~'~.":~/~ ......... ~.r~....: ............................ ~' Municipality 2. State existing use and occupancy of premises and intended use an~J OCcupancy of proposed construction: b. Intended use and occupancy .../..../.~~....~. ~~ ,~.,~ ................ / v ................ ........ r'"- .......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...... ~....J~...~..C~... ~.'.,...~-. ,(~:~.(: ~T~ ..... (Description) 4. Estimated Cost ~'Z~ (~.~... ~ ................ 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 ..'/P..'. ....... 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 ............ ./...~....c~......~....; ......................... Rear ......... .~...~..:...~...~.....~ ........... Depth ..... ~,,./.......~.....~....x.. 10. Date of Purchase ........ ~....~..~..~......Nome of Former Owner ...... ...~...o..~..~.....~..;../.~.,~,~,Z,~TZT..... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~../...c?.. ................................... 13. W~ill lot be regraded . ......... ~.~. ........... Will excess fill be removed from premises: ( ) Yes (-<) No 14. Name of Owner of premises .....~'~.d~.....~.......~r~.~:~.... Address ...,.,~.~.~,w ...... Phone No....7....~...~..7/...~..~. Name of Architect .............................................................. Address ................................ Phone Ne ....................... 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. COUN~ oF~.....~~'~ ................................................................................................. being duly sworn, d~oses ond soys t~t he is the opplicam (Nome of i~ividuol signing c~tmcO above nom~. He is the ................................................................................................................................................................................. (Controcter, ogent, corparote officer, etc.) of sold owner or owners, end is duly outhorized to perform or h~ve performed the sold work ond to ~ke ond file this ~pplicotion; fhot ~11 stotements contoined in this.~pplicotion ore t~e to the best of his knowledge ond belie~; ond thor the work will be performed in the monner ~t fo~h in the opplicotion filed therewith. S~om to ~e m~ this ......... ......... , ...... ................................ jUDI~H T, BOKbN (Signature .of applic~t) Co~miss[on Exp~es