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Home My WebLink About8778-z ]rOl~t NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8778 Z Permission is hereby grant.ed to: .~rJm..-~.or/c...~enca..C.a....4~..,..~e-he.]..'t~. 3,' cker to ....er.~C.t..~nd..maint ~tr~..£encJ~ng..az.. per...~.l~i.i, oa.t.t~n ........................................... at premises located at ...P. ik~..~t..&..Lo.v.e...La ................................................................................ .............................................. ~.t..~t.~.¢k ....................................... ~ ................................................... pursuant to appJmcat~on dated .................... ~t~y: ....... ~ .............· ]~r/~...., and approved by the Building Insp~tor. ,iL TOWN OF $OUTHOLD BUILDIHG DEFARTMEHT TOWN CLERK'S OFFICE ............................... ................................. ............................... ....... APPLICATION FOR BUILDING PERMIT Date .................. INSTRUCTIONS a. Thru application must be completely filled in by typewriter or in 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, relatlonsh~p to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is por~ of th,s 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 permi 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 Occupanc~ 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and bther applicable Laws, Ordinances o, 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 admit authonzed inspectors on premises and in buildings for necessary inspections. .... , ......................... , (Signature of applicgnt, or name, if a corporation) ' ...... .................... (Add~ess of applicant) State whether applicant is owner, lessee, agent, qrchitect, engineer, general contractor, electrioan, plumber or builder. Name of owner of premises ...~~....~.'[ ........................................... ! ....................................................... 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'~ License No ............................................... 1 Location of land on wh,~h~, · -~ ~,~r-~_ ~-~.¢- ,~ ~'~pr°p°s~l work wil~e/~done. ~ap/~lo ............ /....,~r~ ......~ ....... Lot No ........................ Street and Number ,~M~-~.~.....~..,~'~.,,/,~'4~...'~~./.~.~...~/., .......................................... ,~/.,. '/ 1~' / ../ . ~ ~ Municipality I 2. State existing use and o6~bl~dfl:rr_~r~is-~-~ff~ ,n.~'d~duSe and occupancy of proposed construction: a ExisJting use and occupancy ..... ~'~~C.,,~7~_ ......... ; ................. i ...................................................... property hnes. Gwe street and whether interior or corner lot 3. Nature of work (check which applicable) New Building ............... Addition .............. ..,hMteration ........ Repair .................. Removal ............... Demolmon ............. Other Work ............ --F.~..~ .............. (Description) 4. Estimated Cost ................................ .~....r_.~.~: .~...? ...... Fee .................................. /...,~..,...~....o. ............................. (to be paid on filing th~s application) 5 If dwelhng, number of dwelling units ........................... Number of dwelling units on each floor .......................... If garage, number of cars ................................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of existing structures, if any' Front ......................... Rear ................................ Depth .................... Height ........................ Number of Stories ........................................................................................................... D~mens~ons of same structure with alterations or addmons Front ................................... Rear ...................... Depth ................................ Height ........................... Number of Stories ............................... 8 D~mensions of entire new construction. Front ................................... Rear ............................ Depth ....... Height .................... Number of Stories ........................................................................................................... 9. S~ze of tot. Front ...................................................... Rear ......................................... Depth 10. Date of Purchase ...................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are s~tuated ......................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation' . ....................................................... 13 Will lot be regraded ............................./OIIIIIIWll]' excess fill be removed~/~~ ./,r ~'7-fr°r~pr'e?ises' ( .g Yes ( ) No 14. Name of Owner of premlse~/'/~.,~:.~../~.~l~....: ........... Address~/~.,~/~.~phone N~.]~..;..¥.....~.¥.J. Name of Architect ................................................ Address ................................ Phone No ...................... Name of Contractor .................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether red,cate set-back dimensions fron ,street names and indicat~ according to deed, and COUNTY 0 F ,.~__~./~. · .,,~ ........ ~'a'~ .............. (Name of individual signing contract) above named being duly sworn, depc ses and soys that he ~s the opphco. He ,s the ......................................... ~.tNI..Z.~'CC~.~..~!.~ .............................. ~ ................................................... (Contractor, agent, co~orate ~fflcer, otc ) , of said owner or owners, and ~s duly authorized to perform or have performed the said work and to ~ke and fi th~s applicahon; that all statements contained in th~s apphcation are true to the best of his knowledge and behe¢, a~ thQ~ the work wdl be performed m the manner set fo~h in the apphcation filed therewith. .......... ......... ;.., ....................... NOTARy PDBL~C, St~t~ ~ff N~v~ Yor~ No 52-~]2585~), Suffn~k