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Home My WebLink About8861-zTO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) Permission is hereby granted to:~ Build new one famil.y,, dwelli~$ ' ~ u'.. - - .... ': ...... :'YY"?~':: ......... : ..... Y: ............................................................................... ,- "~ .... . ~ ~ ~- .~. ....... -.. .~ ~nd approved by the - APPLICATION FOR BUILDING PERMIT TOWN OF SOUT. OL:, BUILDING DE,P,A. RTMENT TOWN CLERK S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS o This application must be completely filled ~n 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this 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 w~lJ ~ssue a Building Permit to the applicant. Such permu 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 Occuponc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulations, for the construction of buildings, additions or aJterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. (Signature c/ir apphcont, or name, if a corporation) ~z _~ ~ ~/ // ........................ ........ (Address of applicant) ~ ~/~ State whelher applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ ............. ........... ..................................................................................................................... Name of owner of premises ..... ~.~.~,~ ...... ~~ ......... ~mC~...~.Ch~ ~.~ ~.~ .......................... If apphcant is a co~orote, signature of duly authorized officer. ~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... /..~...~...T....~.. ......................... Electrician's License No....~...~..3..Z....~.. .................... Other Trade's L~cense No ............................................... 1 Lo~ation of land on which proposed work w~ll be done. Mop No ..... ~..~...~-/...~..9..o. ~.. ........ Lot No ....~.....:~.. ......... Street and Number .... ~./.~....~.f~.~.~.~...~ ........ ?..~..~..:.~..~.:......~.~.~....~.~.~.......~...c..c.~,...~..~... .............................. Municipality 2. State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a Exisiting use and occupancy ........................................................................................................................ b. Intended use and occupancy ..~..~.~./.~)..~..~...C...~ .............................................................................................. 3 Nature of work (check which apphcable) New Building .................. Addition ................. Alterahon ........... Repair ............. Removal ............ Demohhor ........ Other Work ........................... (Description) 4 Estimated Cost ...~,.~.~.P.. .................................... Fee ~/~ (to be pa~d on fihng this applicahon) 5 If dwelhng, number of dwelhng umts .......... / .............. Number of dwelhng umts on each floor ......................... If garage, number of cars .......... J ................................................................................................................ 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ................... 7 D~mens~ons of existing structures, if any' Front ......................... Rear ................................Depth ................... Height ........................ Number of Stones .................................................................................................... D~mensions of same structure with alterahons or addmons Front .................................... Rear ...................... Depth ............................. Height ................... Number of Stones .............................. 8. Dimensions of ent,re new construct,on' Front ......... ..~...~..~..L'. ........... Rear ...... ,~...~. ;..?..~'. ....... Depth ............. Height ................... Number of Stones ........................................................................ 9. S~ze of lot Front ................................................ Rear ......................................... Depth ............................... 10 Date of Purchase ................................................. Name of Former Owner ....~...o..6..¢.:~.H.....~.~.~;...F? ..................... 1 1 Zone or use district in whmh premises are s~tuated .................................................................................. 12 Does proposed construct,on violate any zoning law, ord,nance or regulat,on: ........ .?....o.. ..................................... ii 13 W~II lot be regraded ............................ Will excess fill be removed fro~ premises: ( ) Yes ( ) No 14 Nome of Owner of prem,ses ....~.~.::,:.~..= ..... :~.~..~.~..~ .... Address .~&~.~..~..~..~!~.~.....,A~..~ Phone No...~?.S..?.~.~ Nome of Architect ....6~./.c.c.4,~/~t....~..~.~.~..5. ............. Address .L~..~...~/..~.¢..~.....~..~/.. Phone No....~..~..~.:~.z.~. Nome of Contractor .,~..c~? .~..~..vs.~C..°. ............... Address ~m~7....~...~..?.~.....~.~.. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and ~ndmate all set-bock d~mensions from property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORIC. , IS COUNTY OF ....6-'~..~(/~.././.~ ......... ~- S ......... ~./~..../~.~..'...~~ ................................. be,ng duly sworn, deposes and soys that he ~s the opphcan~ (Nome ~f individual signing contracf) above named He ~s the .... '~"-'~ ' . ................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duty authorized to perform or have performed the sa~d work and to make and ill.: th~s applicahon, that all statements contained ~n th~s apphcohon ore true to the best of his knowledge and behef; an, tho~ the work will be performed m the manner set forth m the apphcat~on filed therewith. Sworn to before me th~s da, of '. ....... .......................... ./.~.~/~/~_. '(Signature of applicant) ]VOTARy PUBLIc, Stat~ o! N~o. 52'9157080 . .5'u",ro~l~*' lerrn Expires March 30, LOT ~ LO'f TH[ OFF'lETS OR DIMENSIONS SHOWN HEREON, FROM THE PROPERTY I. INl$ TO TIdE STRUCTURES. ARE FOR A SPECIFIC PURPOSE AND USE, THERE, FORE TH,IY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ElEC- TION OF F~NC~S, ADDIIJ~NAL S~RUCTURES, OR ANY OT~IER IMPROVEMENT. OFFSETS & DIMENSIONS TO CONCRE"I'E FOUNDATION LOT NUMBERS SHOWN THUS ~EFEIt TI:) THE MAP OF ~ILED /.lov' 'Z4, OF PROPERTY AT FOR: ,, SCALP= 1" = 4.0' · INDIC,I~T£~ ~TAK~' · INDIC&T£~ MONUMIr"NT UNiI[O BTATE8 STANDARD DATE oU-rH OLC) TOWN OF ~Z~UT SUFFOLK COUNTY, N, Y. cFa. user, omngham 516/261'1717 239 .a~ ,' qoat~ TrTL~ NUMIIER 1NE OFFSI~IS OI1 DIMENSIONS SHOWN HEREON, FROM, THIE PROPERTY LINES TO THE STRUCTURES, ARE FO~ A SPECIFIC PURPOSE AND USE, THERE~ FORE THtY ARE NOT INTENDED TO MONUMENT TH~ PROf~ERTY lINES OR ~O GUIDE THE EREC- TION ~ F~NCES, ADDitiONAL STRUCTURES, OR ANY OTHER IM~VEMENT OFFSETS & DIMENSIONS T0 C~'~NI[:RETE FOUNDA11ON LOT NUNIBERS SHOWN THUS REFER TCI THE MAP OF ~OU'I' H FIL~. /,.l: ?..141 141 SCALE 1 ~ = 40' DATE · INDIC~ITE8 STAKE: · iNDICIITIrS MONUMENT UNITED ,B'rATES STANDARD ~,'~ w,',c--~.','/- ~ ~' OF PROPERTY AT OUTH OLD TOWN OF SUFFOLK COUNTY, N. Y. coFa. uscr, rrmgham J~u F'VE'~ OI~S LAND 516/261.1717 239 L,~ ~ :3 u APPROV[D AS NOTIFY BUILDING DEPARTMENT ? A . "'/L ro;/ h