HomeMy WebLinkAbout7148-z ~0~,~ NO. $
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMI~E~S UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)_
N? 71 8 Z
Permission is hereby granted to: __ ~ ; /
..... .~ ...................................... ............... ; ............. :t=
to ...~ ............................... ~ ........................................................ ; .........................................................
at premises located at ...~?..~.~ ...... ~.~...,..Z.~.L~...t.~.) .......... J~./.,~.~.. ....................
pursuant to application dated .... :.?.. ~.. t'~"~i~.?, 1 ',
........................ + ...... . ........ and apProved by the
Building Inspector. :
Fee ~,,. ......................
Building InSPector
Examined ................. ~..//.'~/.~t ..., ~ '/
Approved ................... -2..~L...,1~...~.-1,., I9~'.. ...... Permit No .......................... ' ...........
TOWN CLERK'S OFFICE ~ ~'-2 ~ ~7 ~ ~
SOUTHOLD, N. Y.
Application NO .................................
(Building Inspector)
APPLICATION FOR BUILDING pERMIT
INSTRUCTIONS
bate" '? / '
........... , ................................... ,19..C:(....
o. This application must be completely filled in by typewriter or) in i~k and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relatidnship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application.
c. The work covered by this application may not be commenced beford issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue q Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the worl&
e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment 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 or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed
The appl'cant agrees to comply w'th all applicable laws, ord'nances, bu'ld'~g code, housing code, and regulations, and ~'o
admit authorized inspectors on premises and in buildings for necessary inspections.
...... .........
(Signatur~ of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owneF~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................. ...L.: :.,,:...-..(.......; ............................. :., ........................................................................................................
Name of owner of premi/ses ....... i.'.'..:.....::....,,~.;k~..;,,:,.:~(>,....,;...,:..t ....... n :;...~(~,L.:./i:L:i~})[i .......................................................
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 ..............................
Location of land on which proposed work,w~ll be do, ne. Map No.: ....;....:...-m.2 .........>z ........... ~ot Np ........ ~ ..............
~ , ,
Street and Number ........... ' ........ : ........ :2 ............. ......... t.,.M....:..,:..i..~, ..................... t .......... .....i.'L.: .............................
Municipality
State existing use end occupancy of premises and intended use and occupancy of proposed construction:
b.a' Exisiting use and occupanCYlntended use and occupancy
3. N'ature of work (check which applJcaNe): New Building .................. Addition .................. Alteration ...............
Repair .................. Removal .................. Demolition .................... Other Work ................... i ~es ~'~il~'~ i~)'t~')' ........ ....
4. Estimated Cost ...................... ~.'?..~!.;..:'.!...). .................. Fee ;/.' ~ ) 0 .................
(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 ............. /.'.M..~.. ................. Depth ............ .?/,..~.. ..........
10. Date of Purchase ....... ................................................. Name of Former Owner .......................................................
1 I. Zone or use district in which premises are situated ....................................................................................................
12. Does proposed construction violate any zoning Jaw, ordinance or regulation: ........................................................
13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No
prem
14. Nome of Owner of ses ...l. ,¢~ Address .~ ~.~j. Phone
Nome of Architect ............... .L ....................... ...,d ............... Address .....~ .......................... Phone, No .......................
Nome of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAG~M
Locate cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from
property lines. Give street and block number or description according to deed, and shaw street names and indicale
~hether interior or corner lot.
0~/
................................................................................................. being duly sworn, deposes and says that he is the applic~m
(Name of individual signing contract)
above named.
He is the ................................................................................................................................................................................
(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 end file
this application; that all statements contained in this application are true to the best of his knowledge and belief;
thflf the work will be performed in the manner set forth in the application filed therewith. ~
Sworn to ~efore me this / _ ~ / )
(~gnature of applicant)
JUDITH T. BOKEN
No. 52~0344963 Suffolk Caunly~