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Home My WebLink About8876-z FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLET~ION OF THE WORK AUTHORIZED) Ne 8876 Permission is hereby granted to: John W. Moffa~ ................ .(I,~.~2~. ....... .,.q~_~:l~t ...................... ["~:5 - qt premise, s located at ....~AFZ~ :~],~lel..~q, Ofl,~ ..... ~,1~.~..:~ ............................................................... ~::'~""'"': ........... ::.: .............. ,....: ..... :...~oa~ :~, .................................................. : ................... ~ ~ Z'.z~-:-~ ~' ,'/ z~> '9* ~_ ~ ~ ..................................... ~ PP ic*tio~ d~._:.~..:...,?.3 ........... q~r-~-, ..... ~. , ]~ ~ and o ( , ;~. ~. :~. ~ .z~:~:~O ~ -:. ' : .... ~. ~ ~..~. ~ -_' ..... ~ -- ., , pprov~ by the TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y, Examined .........~....~., 19.~.~... ,~ov~ ................. ~..~. ....... ~...., ,;Z~] ~,~ ~o .~...~...~. ..... Disapproved a~ ...... APPLICATION FOR BUILDING PERMIT Date ........ ~ ...... ..~....~?. ................ , 197...~_... INSTRUCTIONS Application No .... ~......?...~... ....... a. This 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 Plut plan show~ng Iocahon of lot and of buildings on premises, relationsbp to adjoining premises or public streets areas, and g~ving a detailed description of layout of property must be drawn on the d~agram which is part of th~s applicatio c The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this apphcation, the Building Inspector wdl issue a Budding Permit to the applicant Such pern 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 tl 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 with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises .and in buildings for necessary inspections. ................. ~.~..~.~ ..... ~.:....~..~~ ............. (Signature of applicant, or name, if a corporation) ........... ..f..~ ...... ~¢.x.. ........ ~~.!ck. ................. (~Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd~- ........................... ~ ........... i~C ..... '~'.'i~i~;~Z'ZZZZZZ'Z"ZZ'ZZ Name of owner of premises .................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. ~.~.......~.. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... X Location of land on which proposed work will be done Mop.No · . ............. ( ..... .~ ......Lot No_~..../..t .......... Street and Number ......... ....... (~...~..'~/(. ................................. ..~.'r~..~..?..i..6-...z. ......... t Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ................. I..~ ................. ~..../ ....................... ~. ............................. b Intended use and occupancy ....................... .~.~..~.~~....~.,~~//~ ~ .................... 3 Nature of work (check which apphcable) New Bui]d~ng ........... Addition ............ Alteration ....... Repair ................. Removal .................. Demolition ..... Other Work .....u (DescrJpt~"~---i~r~)' ....... 4 Est,mated Cost .......... ..~......~....~. .............................. Fee .... ~..~......~.... ...... :. .................................................. (to be pa~d on filing this apphcat~on) 5. If dwelling, number of dwelhng umts .......................... Number of dwelhng umts on each floor ........................ If garage, number of cars .................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........ 7 Dimensions of ex~stmg structures, ff any' Front .........................Rear ................................ Depth ............... Height ....................... Number of Stones ........................................................................................................... Dcmens~ons of same structure with alterations ar addmons' Front .................................... Rear .............. Depth ................................ Height ....................... Number of Stones ............................ 8 Du~ens~ons of entire new construction. Front .................................. Rear ............................ Depth .................. Height .................. Number of Stor~es ................................................................................................. 9 S~ze of lot' Front ...................................................... Rear .......................................... Depth ............................ 10. Date of Purchase ...................................................... Name of Farmer Owner ..................................................... ] ] Zeno or use d~str~ct in which premises are situated ......................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ...................................................... 13 Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Address ................................ Phone No .................... Name of Architect ................................................. Address ................................ Phone No .................... N(u~e of Contractor ........................................... Address ................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and indicate all set-back d~mensions fro property hnes Gwe street and block number or description according to deed, and show street names and ind~ca whether inter~or or corner lot STATE OF NEW YORK, [ ¢ c COUNTY OF .......................... f'"~ .................................................................................... bmng duly sworn, deposes ,and says that he ~s the apphc~ (Name of ind~wdual s~gning contracf) 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 application, that all statements contained m this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the apphcat~on filed therewith Sworn to before me th~s Notary IPubhc~ . ................................................... County ................. ..~.... ............. (Signature of applicant)