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Home My WebLink About8768-zTO~VN OF SOUTHO].D BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8768 Z Date ........................... ~Tt~ ...... 3~...:..,~ ] 9.06.. Permission is hereby granted to: : · -C-Ia ~enee-- &-. ~ i'].~e &'.-' Gl ~ aeC- ......... ........... ...~.?.;I,~m.~...~ .............. ..~. ~.tJ,.t~.~ ....... ~o ..~me c.t ..ami..ma ia/mi~.2~nC.in&.m s.. ~e~...a~ l& o~t ~ ....................................... .~ .... at premiss located at .... ~,-.-~e---Aa~e ................................ ~ ........................... :-t .............. pumuant to application dat~ ........ Buildin; In~ector. Approved- 19.Z~.,. BUILDING DEPARTMENT \ // TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,/ Permit No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~ Inspector, with 3 sets of plans, accurate plot plan to scal~e..Fee according to schedule. ~ b. Plot plan showing location of lot and of buildings on premises relationship to adjoining premises or public streets o~ r~ areas, and gi~,]ng a detailed description of la~out ofproperty must be drawn on the d]b~am which is part of this application. c. The.work covered by this application may not be commenced before issuance-of Building Permit. m' d. Upon approval of this application, the Building Inspector will issue a Building 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 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings 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 .............. ~..~uz~q.~.~:~..~,/,~e~, ....................................................................... 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 ............................................. ~ e Other Trade's License No. .............................................. uCo. ~)'~.o~ 9 an~/Yo._ ~ of/-o.~.(~ 1. Location of land on which proposed work will be done. /Wap No.: ........................................Lot Nc~--..~.....e~...~...2~.~. pa~e ~/ Street and Number ..... ~..~/~,../,~/~, ................................................................................. ; ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ................... ~ ........................................................................................ 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .ff.~rZ, C~..,~l,..,~ ................ ~, c, TO (Description) 4. Est,mated Cost .........~.~'.(~.^~. ................................... Fee ..Z ..................................................................................... (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 occt~p, gj3f. v~ specify nature and extent of each type of use .............. .'. ............ 7. Dimensions of existing structures, if any: Frd'~t ......~ .................. Rear ................................ Depth ...../...0~.. .......... I*l~lght ....~...~...~....~...c~.. 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 ....... -/00..~ ............. Depth ........................ Height ....... ~..~..~'. ...... Number of Stories ...,..'". ............ : .............................................. :. ................................................ 9. Size of lot: Front .......... [/.~. ........................................ Rear .......................................... Depth ........ l.l~,~' .................. 10. Date of Purchase .............~.~f~..;~j...l.~5.Zf ................. Name of Former Owner ....~..~?..../~.~.~.~.~ .................. ! 1. Zone or use district in which premises are situated ....................... J~ .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ........................................... 13. Will lot be regraded . ........ z~o ............... Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises .~,~/~-~l,ce,.-~-~/~..~Addre~.~/.-e//.¢,./,,~,. Phone No~.c~.-..l/~ ....... 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 whether interior or corner lot. I,(4,6/0gA (Signature of applicant)