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Home My WebLink About8843-z8843 Z FOR~ NO. 2 TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) _Permissi°n. is hereby gr~$atkoslr~~...A...~..'?...s... · : Building Inspector [ FOyer NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTNOLD, N. Y. Examined ........... ~....~....., 19., ..~....~ Approved ..................... !.! ........ ..~....., 19.A..¥.~7~ Permit No ................................... Disapproved a/c .......................... APPLICATION FOR BUILDING PERMIT Application No.....(~.....~.~..YJ ......... Date Sept 3 19 76 INSTRUCTIONS a. Th~s applicahon must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buddings on premises, relationship to adjmmng prem,ses or pubhc streets areas, and g~ving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatio c. Zhe 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 apphcant. Such pern 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 Occupan. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Braiding Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions ar aiterahons, or for removal or demohtion, as herein describe The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.- 0~ner Name of owner of premises ..~..o.~.e~..h...~....A.~.e...~....~...~.~..~.o...~..~.~ ................................................................................ If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 0w~er Budder's License No ..................................................... Plumber's bcense No ................................................. Electrician's License No ............................................ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ....... ~ ......................... Lot No. ~ Street and Number ~.]:.e.~..D:.~..~.~'c~:~.(~.~..~..?...)~..~.~'~...~...j~.~.~.~.~.~.'e. ............ ..~..o.~.~..o..];.~. .................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construchon: a Exisiting use and occupancy ....... ~.~...e.?7..~.~..~..~. ................................................................................................... " with fencin~ b Intended use and occupancy ........................................................................................................................... 3. Nature of work (check which apphcable) New Buitdmg .................. Addition .................. Alteration ............. Repair ................Removal .................Demoht~on ................... Other Work ....... ~ .e..zz....0. ;f,~ j; ......................... (Description) 4 Estimated Cost ? ..Fee ...1.~.,.QO ..................................................................... (to be prod on filing th~s applicahon) .5. It dwelhng, number of dwelhng units ........ ..O..~..e. ............ 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 ex~st~ng structures, Jf any' Front .......................... Rear ................................ Depth .................... Height ........................ Number of Star,es ...................................................................................................... D~rnensions of same structure with alterations or addmons: Front .................................... Rear ........................ Depth ................................ Height ........................... Number of Stones ................................ 8 Du'nensions of entire new construction: Front .................. , ............... Rear ............................ Depth ................... Height ................... Number of Stories ......................................................................................................... 9 Size of lot: Front ...~..6..1 ............................................... Rear ......... .~.0.c). ...................... Depth .~....2.~_.+. .................. 10. Date of Purchase ..................................................... Name of Former Owner .................................................... ....... B ........ disJ~ ................................................................. 11 Zone or use distr,ct in which premises are situated " " 12 Does proposed construction v,olate any zoning law, ordinance or regulation ......... D.Q ......................................... 13 Wdl lot be regraded ....... ..~..O.. ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses ...~....&.....~.....~..~..~...~..o...s.~..:l: ............... Address ........ ..~..°...~.~..]9:.°..1...c1: .... Phone No .................... Nome of Arch,tect ........................................................ Address ................................ Phone No .................... Nome of Contractor ................ ~.~...~..e. ............................... Address ................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and ~ndicate all set-back dimensions fro property hnes Gwe street and block number or descnpt~on according to deed, and show street names and ind~ca whether interior or corner lot STATE )F NEW ~O~1~, , ~¢c COUNTY OF .... ~.¥~..].Z.:.O...~... .......... f ~.-~ ..................... ~.J[P.~.~...~i~t~.QIS~D~, .................................... being duly sworn, deposes and says that he ~s the apphca (Name of individual signing contracf) above named He ~s the ........................................... O',~'te~. ................................................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~ th~s apphcation; that ail statements contained m th~s apphcat~on are true to the best of his knowledge and behef; a~ that the work will be performed in the manner set forth m the apphcat~on filed therewith. Sworn to before me this .................. · ~- .... day of ........................ .~..~.~.~.. ........ , 19 .~6./.~ ~ ~ ~ ~' ,'"'~ r,. ,*.. Nota ub,ic,. ............................. ..... Co.n ....................................... of ,x~~ (Signature applicant) ~',~OTARY PtI,BLIC SI,Itc al ~lew Yor~ No 52 g125950. Sulfu;kCu Term [XD~¢e$ March 30 ]o _