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Home My WebLink About8771-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ~ . ::' ..... ..... .......... ............ ~u?ucint to dpplicotion dated ............................. , ] and appr;ved by the .... g F~;~ $/.~.,~.....: ............ Building Inspector J~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. '"~~ (Building ~s~ctor) APPLICATION FOR BUILDING PE~IT ~ I NSTRU~IONS e~ Application No....(~...~....Z.Z .......... a This application must be completely fdled in by typewnter or ,n ink and submitted in triplicate to the Buildin£ 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, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of thru application. c. The work covered by this apphcation may not be commenced before issuance df Building Permit. 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 wheteyer until a Certificate of Occupancy shall have been granted by the Budding 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and ir~ buildings for necessary inspections. Store whether opplicont is owner, lessee, agent, orchitect, engmeer~ general contractor, electrioan, plumber or builder. If ,pplic~n¢ is ~ co~orote, sion~ture of duly ~uthorized ..... (~me ~nd t~e-of co~orote officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No..~.....~.. Locotion of land on which prope~Jed wqrk will be done Map No.' ................................. Lot No ......................... State existing use and occupancy of premises and in:ended use and accupanc~ of proposed construction: a Exisiting use and occupancy .... ~'./~/~ .... &,~.. -- ' 3. Nature of work (check which applicable). New Buddmg ....... Addition . I arian .... Repair ................. Removal .................. Demolmor. .................... Other Work, ............. ~' (Description) ..7. 4. Est,mated Cost ..... .~.~,~.~.... ............. ./.....~(.?~... ........ Fee ..~.?~.........-~... ........... : ................................................ (to be pa~d orl fihng thru apphcahon) 5 If dwelhng, number of dwelhn0 un,ts .......... Number of dwelhng umts on each floor ................ If garage, number of cars ................................................................................................................... 6 ff business, commercial or m~xed occupancy, specify nature and extent of ~ach type of use ........ .~y~. ...... ~' 7. D~mensions of exmting structures, ff any. Front ..................... Rear ............ 2 ................... Depth ................ Hmght ........................ Number of Stones ................................................................................................ D~mens~ons of same structure with alterations or add~ttons. Front ................................... Rear .............. Depth ................................ Height ................ Number of Stor~es ......... ~. ...................... o 8 D~mens~ons of entire new construction Front .................................... Rear ............................ Depth .................. He~§ht .................. Number of Stones ................................................ r ................................................. 9 S~ze of lot Front ............ ~Z'..m~..o..~../'J. .................. Rear ...... /..~.,~.:..l~.. ..... : ...... :~... Depth ...~'..~'..~.-...~.~'T. ...... 10. Date of Purchase .......... ~..-.~,~.:¢....~7.~.. .................. Name of Former O~.ner J....~../~.~.~0"~.~...~.,.."~t~l~'..~. .... 11. Zone or use distr,ct fn which premises ore sftuoted ........ ~I~.,S-J~.~,aZ~.~./~.~ ...................................... 12 Does proposed construction violate any zomng law, ordinance or regulation: .......... t~..Q. .................................... 13. Will lot be regraded ........... ~..~. ......... Will excess fill be removed frocn pre4nt~es: ( ) Yes (~'~ No 14. Nome of Owner of prem,ses ....... d.~',~.t~/ .......~..~...~'..~.j.r~... Address/~..~,~/~y, ..... Phone No. Name of Architect .................~',~' .................... Address ....~.~.~.~;~.~.. ............ Phone No ....................... Nome of Contractor ............... .~..~..~'.~ ................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and dmtmctly all buddmgs, whether ex~st~ng or proposed, and inktlcate oil set-back dimensions from property hnes. G~ve street and block number or descnphon accordmg to deed, ahd show street names and indicate whether interior or corner lot STATE OF NEW ~.P.~.~. ~/ . ~ S S COUNTY OF ~..~' ' .......................................................................................... being duly sworn, depos,,s and says that he is the apphcan (Name of indiwdual signing contracf) above named He ~s the ............................................................................................................................................................... (Contractor, agent, corporate officer, otc of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fik this apphcohon, that all statements contained ~n th~s apphcahon are true to the b~st of h~s knowledge and behef, on~ that the work wilt be performed in the manner set forth in the apphcahon filed therewith. Sworn to before~ne this I ...................... of ................ . t;o ~r',, Pubhc, State of New 'for~ ' Ilo 52 3M4963, Suffolk County -,?-'/ Ccmm,s'.'3n E,~plres March 30, ].g//