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Home My WebLink About7500-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFI~,E SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS£S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7500 Z Permission is hereby granted to: .... ~r..9.L~...~q,~,.e~. .......................................... ......... l~..2'~ee..]Bead, ..................................... ~o ....]~.~,3,~..a~Y...~.l~QrlL.l~anJ .................................................................................... Lot Jla ,.q l~.~q~. . at premises located at .......... .1~. .............. ~l~..q..a.' .............................................................................. ......................................... ..P.~.e....~,e.,e........~...~ ........... ..~..~.e.~. ................................................... pursuant to application dated .................. ,$,~J~'~,~.~.....;...~. ........ , 1~1:...., and approved by the Building Inspector. Fee $~...O..?...Og... ............ Examined . :. ................. , Approved .................... ~ ............, 192..~.. Permit No..Z'...~.....~....~..,..?.. .......... (1~ /(Y~ I ~ t~ ~'"~r~"~r~ '~':'"'IL~;"~ ............... INSTRUCTIONS o. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plut plan to Kale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsh p to adjo n ng premises or public streets o~ areas, and giving a detailed description of layout ofpmperty 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 a Building Permit to the applicant. Such parmit~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bu Iding Department for the .issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Tork, and other applicable Laws, Ordinances or TR~egulati,o. ns, .for the c.onstruct!on ~. bu!Jding.s., ,ac, k.I. it!ons or a. lterations, or for removal or. demolition, as herein described. ne app,canT agrees to comply w,m a~, app,came laws, ora nonces, building c..ode, houmng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary Jnspact~ons. State whether applicaTLis owner, lessee, agent, arcl~ect,~,,~neer, general contractor, electrician, plumber or builder; .......... ................................, , ................... ...... ......................................................................... Name of owner of premises .....~..~...~...0....~..'../~.'"'~..~-~....~..'.~......~T'..~.. .............................................................. If applicant is a corporate, signature of duly authorized affiX. ' (Name and title of corporate officer) · Bu der's L cerise No :. ........ : .................... , : .._.. ............. \ Plumbers License No ................................................. an's' Li N -- Electrici cense o ...... Othe~r Trade's License No ............. ..~--... ............................. il/2 ~ ~- 1. Location of land on wh ch prapo~s~ wjJJ./~-dona /V~e,~lo ' ~....~.~~.. L~t Street and Number .............. .~..--~..-~ '..~ ~....i::"~'~~ ........................... F, //77 " ':'" .................................... r ...... 2. State ex,sting use and o~cupancy of p.r~,~' es ar~n,ended use and occupancy of prapa~d comtructjon: a. Exisiting use and occupancy ...... ~.~ .............................. : ....................... ,.. 3. Nature of work (check which applicable): New Building.. ................. Addition ~...../. ......... Alteration Repair .................. Removal .................. Demolition .................... Other Wq~ ../: ............................................ . .... ~ ~ ..~*~ (Description) / D ' 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 ................................................................................................................ 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 ................................ 10. Date o~.~Pl~chase ..... ;. ................................................. 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 ~e regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... 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 property lines. Give street and block number or description according to deed, and show Street names and indicate interior or corner lot. STATE OF NLR~/~,~' icc COUNTY OF ..~/~/...~E.....~:.. ...... ............................... tJ~' .................... v ....................................... being duly sworn, d~o~s and says t~t he is the applicant (Na~ 6f ~ividual sign~ c~tmc~ He is the ................................... ~ ............................................................. : ............................................................ (Contractor, ag~t, co~rate officer~ ~c.) of ~id owner or owners, and is duly a~rized to perform or h~e performed the said work and to ~ke and file this application; t~t all ~atements contain~ in this application are tree to the ~st of his kn~ledge and belief; and that the work will ~ ~rfor~ ~ the manner ~t fo~h in the application filed the~. Swam to ~o~ me this . ........ ......... ~~' ~ ~O~ ~o*~ (Signa~re of applicant)