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Home My WebLink About8859-z FO]~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT sla~ ~188 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8859 Z Permission is hereby granted to: Frederi~ P. Rich ................... .~..~..~.o...!...~ ......................................... Building Inspe~c~tor ~ FORM lq'O, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~.Z.~.. ....... , 19 ? ~ ................ .......... . .... ..... ................. ........... APPLICATION FOR BUILDING PERMIT ~ Application No....~...,.(~....~..~. ............ Date ..... l~t~llD~.. ~5 ............... 19..7..~. .... INSTRUCTIONS a This application must be completely filled in by typewnter or in ink and submitted in triplicate to the Building 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 or areas, and giving a detailed description of layout of property must be drawn on the d~agrom which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit d. Upol~ approval of this application, the Building Inspector wdl issue a Budding 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 far any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 apphcoble lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electriczan, plumber or builder. Name of owner of premises .............. ~.:;I~I~I~I~G..~.A..~kC~ ......................................................................................... If apphcant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Electrician's License No ................~ .................... Other Trode's License No ............... .x4'. ...... ~ ................... Municipality State ex,sting use and occupancy of premises and in~.ended use and occupancy of proposed construchan: a. Exisiting use and occupancy ........... x~lt~;~.~.'~l~.. ~l~.~.~¢~;~.el~l~.~,?,~..~ .................................. 3. Nature of work (check which applicable). New Building,. ................. Addmon .................. Alteration ............ Repmr .................. Removal .................. Demolihor. .................. Other Work ........ .~.~. · .............................. (Description) 4 Estimated Cost ........................................................... Fee ........................................................................................ (to be paid on filing th~s application) 5. If dwelling, number of dwelling units ...... ..~.?...~.~ ........... Number of dwelling un,ts on each floor .......................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... .~.,~J~* ............ 7. Dimensions of existing structures, if any: Front ...... ..~.*...~.~ ............ Rear ................................ Depth .................... Hmght ........................ Number of Stories .............................................................................................................. Dimensions of same structure with alterahons or oddmons: Front .................................... Rear ........................... Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ..~..~..~ .................... Rear ............................ Depth ...................... Height ................... Number of Stories ............................................................................................................... 9 S~ze of lot' Front ......... .N.~.A..*. ..................................... Rear .......................................... Depth ............................... 10. Date of Purchase ......... ..~.~..~.? ..................................... Nome of Former Owner ........................................................ 11 Zone or use district in which premises are situated ...... ..~..~..~ .............................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation' . ...... .~...*..~..~,. ....................................... 13. WHI lot be regraded .... ..N~..~.~ .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..,~...~.~.~..~...~.~..~.~...,..J~..~.~. ........... Address .~...0..~..~.~..~.. ............ Phone No. ?.~..~..-...3..~...3.§... Name of Architect .......................................................... Address ................................ Phone No ....................... Name of Contractor ....................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and red,cate all set-back dimensions frorr propcrty lines. Gwe street and block number or descriphon according to deed, and show street names and /nd*cat~ whether interior or corner lot c-q-ATE OF N~J~, ~ S S COUNTY OF ...'?..'?.~.t.~...~.. ............ f ' ............................................................................................... bemg du|¥ swor~, de~oses and so~s t~t .~e (Nome of individual signing contract) above named He is the owner (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or h(~ve performed the s~id work and to rn~ke this apphcation; that all statements contained in this application ore tn JO to the best of his knowJ~lge ami belief; ti,aT the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th~s ........................ aay OT ............................................ , ! ........ ~'.~, _~. . ( /,,,~j" / ~' Notary Public,. ........... ...................... County ... ~/'..~ .....~.......k~....~J..~ (SignohJre of opp~[ont)