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Home My WebLink About8873-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8873 Z Date ......................................................... 19 ........ Permission is hereby granted tl~ ,.3 ~' /~ , to ................................................................. jr ........... ?- ................................ , ....................................... Examined ..... ~.....~,..., TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/c .~Z....~:~. ....................... :~.[:'.~ .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~' in ink and submitted in triplicate to the Bull, Inspector, with 3 set~ 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 street areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this opplical 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 applicant. Such pe 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 Occupc 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buildings, additions or a~terotions, or for removal or demolition, os herein descr', The opphcant agrees to comply with all applicable laws, ordinances, buiiding code, housing code, and regulations, on, admit aulhorized inspectors on premises and in buildings for necessary inspections. .............................. ~-~ignature of,~t~r name, if a corporation) ' (Ad. dress'of applicant) - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bud, ............. :....: :....'.-. ........... : ......................................................................... Name of owner of premises ~.:..~. ...... ~, .............. If applicant is a corporate, signature of duly authorized officer. ~ ~) ................................. (Name and title o'f corporate officer) Builder's License No ...............~....: ............ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Co.~ ~t-~ Location of land on which proposed work will be done. Map ~qo.' ....... ?. ?..?.. .................. Lot No Street and Number .[,...~..,~.....~,.~--,~.T~'x.....~..t,~..~.: ......... ..~'-~..~..,'..~.,L...~...L...~'..-¢..C'_, ...................................... Municipality State existing use and occupancy of prerj~Ls, es and intended use and occupancy of propased constructian' a. Exisiting use and occupancy .......... ~ .......................................................................... b. Intended use and occupancy q~(::~'\ L\ ~L~...~ ~ 3. Nalure of work (check which applicable) New Building .................. Addition .................. Alteration ........... Repair .................. Removal .................. Demolit~or .................... Other Work ....~.....~.../'.~.~ ........................ .~. ~ (Description) · 4 s,,ma,ed Cos, .... ................ ' ..... ..... ....................................................... (to be paid on filing this application) 5. If dwelling, number of dwelhng units ...~.~ ~ ......... Number of dwelling units on each floor ........................ If garage, number of ~rs ......... I .~.~ ............................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ........................ 7. D,mensions of existing structures, if any: Front ...... ~.~. ............ Rear ........ ~.~ ............... Depth ..... ~..Z ........ Height ...... ~.( .......... Nu~er of Stones ..... L ...................................................................................................... Dm~ens,ons of same structure with alteratioos or additions: 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 ........ /~Q.~ ................................... Rear . /~6 / ..... Depth /~' 10 Date of Purchase //' ~' ~ Name of Former Owner L.~,$)./~.~. ~ 11 Zone or use district in which premises ore situated .............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation' 13. W, II lot be regraded ......................... Will excess fill be removed from premises: ( ) Yes (~No 14. Name of Owner of premises~g~.~.~,~<~~_~ddress Cr~.~'~..~.: ~hono Nome o{ Architect .................................................... Address ................................ Phone No ................... M~me o{ Controctor ......................................................... Addre~ ................................ Phone No ................... ~kOT kocate clearly ~nd distinctly oll buildings, whether ex~stin0 or proposed, *nd indicate oli set-~ck dimensions pr~pe~ Hnes. Give street ond block number or description occordin0 to deed, ~nd show street n~mes whether interior or corner lot. COUN~ OF ....g.~..w..~ ...... f .................................................................................... ; b?ng duly sworn, deposes and says that he ~s the apphca (Name of indtvidual signing contracO above name. ., ,~ ,h, ................................... .~.,.L~.~ ................................................................................................................... (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 this apphcahon; that all statements contained in this applicahon are true to the best of his knowledge and belief; that the work will be performed in the manner set fodh in the 'application filed therewith. Sworn to before me this .o,~ ,.,,,,c.. .................. ~~/~ ........... Co.nW ........ ~..~'....~..:....~:~ ........................... ~ ' ~ _ ~ ~ ~ [~ ~ ~ (Si~fatur~/of dpplicant) ' ~ [LIZIB~H gNN H[VILL[ / ' NOT~Y PUBLIC Slate al ~e~ Yor~