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Home My WebLink About7149-z FO~.M NO. ~ TOWN OF sOuTHOLD BUILDING DE~ARTJ~EIqT~ TOWN CLERK'S OFFICE SOUTHOLD, N,'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 71 9 Z Permission is hereby granted to: ~ ~t premises ocated ~t ............................... ~ ......... ........... ,..;..,~. ............... ~ ..................................... ................................................................................. ~=~/,,,...?.... .......... ,.~ ......... , ............................. pursuant to application dated .......................... ;...~..,~..;,~.~;, 19;¢-~,; and ~pproved by the Building Inspector. ~; Fee $ .............. Building Ihspe~tor FO1/~I NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE' SOUTHOLD, N. Y. Examined ~ *~ 19.. Approved ......................... .~.../.?...~.., 19..7.?.;.. Permit No....Z./.......7.......: ............. Disapproved a/c .............. ~~;~.~:~..~.:;..:: ................. .. (Building ~nspector) Application No ................................ APPLICATION FOR BUILDING PERMIT bate ......... .7.. ..................... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according f.o schedule. b. Plot plan showing location of Jot and of buildings on premises, relati6nship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn 6n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue & Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wor~. 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 ~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or {or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnatu~e of apphcant, or name, if a corporat on) ................. . .............. I (Address of applicant) State whether applicant i,~ owner, lessee, agent, architect, engineer, gener&l contractor, electrician, plumber or builder~ .................. ~~....: ...................................... ~....;...~ ........................ .......................................................................... -- Name of owner'S'of prem,ses .__ ................... ,~.~.~'~~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,will be ¢tgne. Map No.: fk'~..~W../r~/~r~.....'~.. Lot No.,...;,~Z.-D ........... Municipa~fity State existing use and occupancy of premises and in.ended use an ofgupancy of proposed construction: o. Exisiting use ond occupency. ~ ..................................................................... b. Intended use and occupancy ......... !....c. ............. F....k. ............. :....i/. ....................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .... (~'-t-'"Ji'-';'~'-':\'~.4~cr pr,on~ ............ 4. Estimated Cost ......................... ~,.0,..~...~..,~....0. ......... 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 .... ..f'~.i~Z..s.'.~i/...~ ................................... Rear .......... ..~..1 .......................... Depth ..... ,.~.....~....O, .............. 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 prem.ses ~.'~:..~..~...'. ....... Address~;,.~., one No ............... ..~...~. ? ".~. ~27), 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 sat.-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. ,~ (Name of individual signing contract) above named. duly sworn, deposes and says that he is the applicom 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 fiJe this application; that all statements contained in this application are true to the best of his knowledge and belief; a~d that the work will be performed in the manner set forth in the application filed therewith. Sworn to be_f~r~, me this '~ - -- /) ~ ~ ,/Z / .......... ~ day of ...., ......... ~...~ ........ , 19~ ~ ~ /7/ ~ JU~l T. ~O~EN ~/ ~ - (Sig~ture of applicant) No. 52 0344963 Suffolk Count~