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Home My WebLink About8846-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. BUILDING PERMIT (THIS PERMIT McU~ST BEKEPT ON THE PREMISES UNTIL FULL COMPLETION ,01~ THE WORK AUTHORIZED) N? 88~6 Z Permission is hereby granted to: ..... .~.E..~.~.:.( ............................................... ....':_'~. ...... ~.:.~......~.LL?.~...z..E?Z ..... ..~...~.,?~,~ l~t~ NO. 1 TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ................... .......... (Bui~din~ Inspoctor) APPLICATIO~ FOR BUILDIHG PERMIT~ ....... ................. I~STRU~IO~S a. Th~s application 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 Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th,s applicatio 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 apphcant. Such peru 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 Building Department for the issuance of a Building Permit pursuant to t~ Budding 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 describe The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing codeM:md regulations,..gnd admit authorized ,nspectors on premises and in buildings for ssary insp~eec~.[ons. (........~.......~...~ .~..~....~,. · .¢..~.~/..c. ..~ f...r~... ...... ....u~....V' .. ~ign, ature pf applicantt, or naF'~-'~J-ck/carporc~iorg ...... 4 ....... :-k ..... .~.k¢,. ........ ~)..t.K...~.....!V....)..:Ltk..f.:..~. ...... ..~..,/.~ (Address of apphcant) ' State whetler applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or build~ .....~. :,~.. ~.r...~. ~..~.../~..: .............. ~ ....................................... ~ ............................................................................................. Name of owner of premises .... .~../.....~..~..:....~...~.....~. ~..~..~..~ ~... ~.......~..~..K~..~ ................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Lmense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................ Other Zrode's License No..'~... ....... .z .................................. 1. Location of land on which~ L/_ ~ ~,,.. ~. e~-)_t, jpr°p°sed work will be d~ne., Map No ................... ~P~ [ ....... .-)LT..~ ...... Lot No ..................... Street and Number ....~A/...~?...~........~?.:.~..-.~rsr..~. ............................... t~¢~..:,'...-'?. ...................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ...~C~ ................................................. ~.. ............. ~.~ ..... .~.......~ b Intended use and occupancy ..... ~.C'..~:T~ ......~ .~..~...~..':.r2...~.c.7 ....... .'~..~..C..~..~..~ ......... ~. ....... .~.'~] .... 3 Nature of work (check which applicable): New Building .... /....x. ........ Addition .................. Alteration ............ Repmr .................Removal .................. Demohhor .................Other Work ................................................ 4 Estimated Cost ................................................. ~'~....f~' ~9~... CD ...... Fee /~' O O. (Description) . .... (to be pa~d on filing th~s apphcahon) 5 It dwelling, number of dwelling units '. ......................... Number of dwelling units on each floor ......................... If garage, number of cars .........2 ......................................................................................................................... 6. If business, commercial or m,xed occupancy, speofy nature and extent of each type of use ......................... 7. Dimensions of existing structures, if any: Front .......................... Rear ................................ Depth .................. Height ........................ Number of Stories ......................................................................................................... D,rnens~ons of same structure with alterations or additions Front ....................................Rear ........................ Depth ................................ Hmght ....................... Number of Stories ................................ /--7/ ,~ 8 Dlmens,ons of entire new construction. Front ......... ~O.. .................... Rear ........ ~g.. ............. Depth ....~.. .......... 9 S~ze of lot' Front ..... ~.~.~ ................................. Rear .......................................... Depth .............................. 10. Date of Purchase ...................................................... ~¢~me ,of F~n~er Owner ...................................................... 11 Zone or use &strmct in which premises are situated . L~..~.).C~v;:..c..?...I....~x...¢~_ ....... /~ .......................................... 12 Does proposed construct,on violate any zoning law, ord,nance or regulation' .~J..(0..~ ............... ;T~." .......... 13. Wdl lot be regraded ............r"J ........... .~6LL~I excess fi~l be removed from premises: ( ) Yes (~ r~o 14 Name of Owner of prem,ses ~t...}~./.k....'~...~...'~...~..'.~....~... ...... Address ................................ Phone No ..................... Name of Architect .................................................... Address ................................ Phone No ..................... Name of Contractor ....................................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and indicate all set-back d~menslons fror property lines Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW ¥--0T~¢,/~ COUNTY OF ...',,...~.~t.:iC/:7..O./.&7. ...... f"'"' ~' ~~/~. ~ being duly sworn, deposes and says that he ~s the apphcar (Name of in~vidual signing contrac~ above named He ,s the .................. .~.~.~.~.~..~ ............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this applicahon; that all statements contained ~n thru apphcohon are true to the best of his knowledge and behef; that the work will be performed ~n the manner set fo~h in the apphcat~, 'f~d therewith Sworn to before me this ................... ....................................... / ................................................... .................... ......................... ~ ELtZ~H A~N ~EVlLLE~ ~TARY PUBLIC, State nt New York~