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Home My WebLink About8870-z FOR-,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8870 Z , ~¢-' ~": Pe~Tnission is hereby granted to: ....... ~..~.....~I~ ..................................... ~ j-~'_ ........... ~~t~..~,..s~;ho3,a ............ ~ ', to ..~...;t;1..~..~...~.x~.:l.,~.~.t,.~.~...b.m:i..~.c]..~.~ ..... C..F.~,.~...~.:/,,~..i.~g). ...................................... at premises located at ..~/~..~4a;t,n...Boad ........................................................................................... ~ ~ ..; .................. ~ ................................ P. eccmt~....~., .......................................................................... ~o' application dated ........... ~ ............ ..~..e.r..~. ..... !.~. ............ , 19..2.~.., and approved by the Irls~ector. FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............ ...... !...1 .............. . .... ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildit 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this appiicatio 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 wdl issue a Building Permit to the applicant. Such perrr 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 tJ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describe. The applicant agrees to comply with oil apphcoble laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whe,~her apphcant ts owner, lessee, agent, archttect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ....... .~.~: ..... ; '-.-;--~,U.,];-.',~-',~-:;.~. ......................................................................................... If apphcant m a corporate, s~gnature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ......... ',,.~...., ................................... Plumber's License No .............. ~ ................................ Electrician's License No .......... ~.,: ................................ Other Trade's License No ............................................... 1. Locahon of land on which proposed work will be done. Map No ' . ......... 6 ........................ Lot No ........ ×~ ......... Street and Number .... /.. ........ ;Lt ..... ~,..(, ................. ~,~)~,~J.o ................................................................................. Municipality 2 Sta~e existing use and occupancy of premises and in'ended use and occupancy of proposed construction: a Exisiting use and occupancy · ..... ~.~.~. ~.~.-_~..J.. ~. ?_~: e ........................................................................................... b, Intended use and occupancy -'. . ~ .~-~.t.~:-~.-. '_"-':g ............................................................ 3. Nature of work (check which applicable) New Building.. ..... ~ .......Addition .................. Alteration ............... Repmr .................. Removal .................. Demolmor. ................... Other Work .................................................. (Description) 4. Estimated Cost ............................................................ Fee ...1.[~,.'3D. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelhng units ............. .Q ............ Number of dwelling units on each floor .......................... If garage, number of cars ......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of existing structures, if any: Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear .................... Depth ................................ Height ............................ Number of Stones ................................ 8 Dimensions of entire new construction: Front ......... .~.. ..................... Rear ............ 3~ ........... Depth .....~(~ .......... Height .................... Number of Stories ......... ~,~, ............................................................................................ 9 Size of lot: Front ........................................................ Rear .......................................... Depth .............................. 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ...... ~:tt..~.~, ....................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ......... ira ........................................ 13 Will lot be regraded ........mo. .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ....... ¥...~.~.~.,~}~:.~.:..,~..±. ................ Address .....~-~.:L..-~..,m.4..¢,-t.~ ..... Phone No. .................... Name of Architect ............................................................. Address ................................ Phone No ..................... Name of Contractor ............ .q:. :,~, [7. .................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror property hnes. Give street and block number or description according to deed, and.~sh~w street names and indicat whether interior or corner lot STATE C'F NEW YORK, COUN-D( OF ............... : ~.~,~ ........... ......................... . ........ ~.~:.ji.~..-.:..%~....:.L ....................................... being duly sworn, deposes and says that he ~s the apphca (Name of individual signing contracf) above named. He ~s the ............................... ;t,~,.,~~. .................................................................................................................................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi this application; that all statements contained in this apphcahon are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ............... ~.~ ..... day of ..................:~.~. ................ , 19.~.. / ~,~ ixtotary rUuiIC~ ...................... ~? .:[. ~..~ .............. ~.~n~ ..... ~ ................ ~:..:..~...~'. ...... ~.~ ..........,- ............. ~ ................. ' ' / (~Jgnatur~/of applicant)