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Home My WebLink About7325-z FOEM NO. ~ TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~: SOUTHOLD, N~ Y. BUILDING PERMIT 7325 Z (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....~ ................. .Z~g......1.~ ............ , 19...~.~. Permissjon is hereby granted to: Mattituek to .....e.~..e..o..~.. ~...~ .i. ~.~.~.~...~..... ~'.e.~.~..e....o.~...~:e e.kl~ ~m] ie~.~;~...Z~r~...6f.t..~de.... at premises located at ...~4'.$..,?.~,..~0 ................................... ~ ........................................................ ................................................... ~.~.t,.tA&~k ....~ J.., ........ ' ....... ~ ......................................................... ': ~ i9.'.~..~,., and approved by the pursuant tO applicati0n,, dated ......................... ~e...~. Building Inspector. Fee $'J.~'.e.(~) ............. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S E×amined .. ~ .... , 19..~ Approved ........................................ , 19...~.~Pemi, No..7..~..~..~..~ ....... Application No, (Building Inspector) INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and ubmitted in triplicate to the Building Inspector, with 3 sets of ptans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshi to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which part of this application. c. The work covered by this application may not be commenced before issuance ~Jf Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildir 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 issuande of a Bud ng Perm t pursuant to the Building Zone Ordnance of the Town of Southold, Su~fatk County, New York, and other applicableJLaws, Ordinances or Regu at~ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ]The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized nspectbrs on premises and n bu dings for necessary inspections. (Signature of applicant, or name, if a corporation) ........... (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. (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 ('~'~(L~(... j~.,~,~, . .;.. t'-~'~ ({~.~C,_~C,.. Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ...... ~..~.._32~....(,,,.~.. ............................................. ; ...................................................... Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ....~..{~.~t,,~.~ ............. (Description) 4. Estimated Cost ..... ..~....~....~...~. ...................... Fee ~J .~..~. .......................................................... (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 occuoancy, 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 ........ '~a~'Depth ..~~... ....... Height ....................... Number of Stor es .. . · ! ~.~ ~,-~' · .................................... ,.~,, ~;:.?.;~ ............ 9. Size of lot: Front ..... ......... Rear ...... ~;..~'...'r~..'~....'... ................ Depth ....... .~../...N~...'...~'...'X... ................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 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 .... .~..:.,~..:..~....~.1~;~.(~ ......... (AddreSS~;~i (Phone No,) Name of Architect ..................................................................................................................................................... _, (Address) (Phone No.) Name of Contractor ..~r~....~....t~..~.~.61/~.....~..:.~.,.....~j~t,~/q/i,~l.[~...v..~.~ ........ ~'~'0'"'~ ..... 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 wheth; er interior or corner lot. COUNTY OF .~~. .................... ), SS .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of indivMual signing contract) He is the...~t~...~.~"'.~Z,~t~'. ....... /~..(~.t/~..~....¢~...~... ....... ~,t~,/~C.~...~........~.~.~..'l~ ...................................................................................... (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 statements contained in this application are true to the best ~j/~i~,kDowledge and belief; and that the work will be performed in the manner · ~r. ~OK~N ................ /.:/ ................ day of ......................... ~_'_~ ...... Notary Publi ...~.-..'...~... ~COU nty ...... .~ ..... ~........~.::'..~.. ............................. ~ (Signature of applicant~