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Home My WebLink About7441-z TOWN OF SOUT.OL0 BUILDING DEPARTMENT TOWN CLERK'S o. This opplicotio~ Inspector, with 3 sete of b. Plot plan showing areas, and giving c. The work covered b' is application d. Upon approval of shall be kept on the premises 'e. No building shall be occu shall have been granted by the (Buildiz Inspector) APPLICATION FOR BUILDING ;PERMIT INSTRUCTIONS Just be completely filled in by typewriter o~ in! ink and submitted in triplicate to the Building~ accurate plot plan to ~ale. Fee according to schedule. premises, relationship to adjoining premises or public streets must be drawn on the diagram which is po~ of this oppJlcotion.~ be commenced before issuance of Building Permit. Inspector will issud a Building Permit to the applicant. Such permit~ throughout the wdrk. in whole or in part far any purpose whatever until a Certificate of ~cupancy APPLICATION IS HEREBY Building Zone Ordinance of the Regulations, for the The applicant agrees to corn admit authorized to the Building Department for issuance of a Building Permit pursuant to the~,~ of Southold, Suffolk and other applicable Laws, Ordinances or :, or for removal or demolition, as herein described. laws, ordinances, building code, housing code, and regulations, and to in buildings for necessary ihspections. State whether applicant is owner, lessee, agent, :act, (SignatQre of applicant, or name, if a corporation) (Address of applicant) eneml contractor, electrician, plumber or builder. Name of owner of premises If applicant isa corporate, signature ~f duJyaut~ortld :icer. ..................x Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... i.Location of land on which proposed work will be done. Mai Street and Number ................................... .,/..~..r.-?.~.... State existing use and occupancy of prer~es and intended use an~J a. Exisiting use and occupancy ~'6L~-k-tL : b. Intended use and occupancy Municipality ~pancy of proposed construction: l~OR.~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPART/vlENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7441 Z Permission is hereby granted to: .g.~,h~z.t..>:~,,c.b~.~..,~.~.' "* ' ~ ....................................... .. ................. ,..,.cmi.~. o.'L d ............................................ Build new accessory sto~=~e bm,~ldzng at premises located at ........ ~.~)...~'~.~.:~,.c~.~:..~O~L ............................................................................ outhold ~, · ~ · pursuant to application dated ........................ ~.~.-JT ....... .~.~ .......... , 19...~.ba, and approved by 'the Building Inspector. Fee $.!..O..t...Og... ........... 3. Nature of work (check which applicable): New Building,. ................. Addition ¢// Alteration Repair .................. Removal .................. Demolition .................... Other Work ............................................... ~/' ,,~ , ~O . _~__~_.__. (Description) O >--' / 0 4. Estimated Cast ......... :..r: .............................................. 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 ex.sting structures, if any: Front .......~'..~.,71 ........... Rear ....... ~...~...~.. ............ Depth ....~....~..z~.,..,.~.... 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 ........................................................ Rear .......................................... Depth ................................ ~.~.. I...~. ~- ,, ',~ ' 10. Date of Purchase ....... :-; ..... I..~'..~.. ....................... Name of Former Owner ....~..~.,~.,/.~g?. ~'~/... ............................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ................................... j7' ................ 13. Will lot be regraded ............... w z~,- ~, ,,./~v"'~'" Will excess fill be removed from,)_~, ,,--_---~Fxpremise~s: ( ) Yes (~') 14. Name of Owner of premises ~....../.x.~.~¢~ ........... Address ..(~.:~'.~..'...//../.~':'...14(.....A..~P'lnone No.'~- "-.~.~(.;.?.:;...~.'..~.~" Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate STATE OF NEW,,'~O[~ ,~,~ l ¢ ¢ ~ :g ~ COUNTY OF ~,t-~'.~.~,,'-~.~....,~....f-,..-, ~' (~'N ~ ............... ~~~ ...................... ~:~ ...... being duly sworn, deposes and says that he is the applicant (Na~ of individual signing contracf) above named. He is the ........................... (~(;~t:~' ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed i~e manner set fo~h in the application filed therewith. Sworn to ~fore me this / / ~ 4' ............ o, ........ ............ ,Z ¢ ~,~to~ Pu~/ / / -~,-~, ~ //-~'~ //~ ~ " ,.~ ,~ ~ , ................ ~..~ ............~ ............... x ...... ....~..~ .............. ;;. ................ ;. ....... : ...................................... ~ ~Jgnature o~ applicant)