The URL can be used to link to this page

Home My WebLink About8884-z FOIZ~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT Lq-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 888 Z Date .......................... Permission is hereby granted to: ................. ~.ai:a..~oa~ .............. So~;l',,.ol,~ ..... 5' · a~ premises located at ..~.~.{$...~i~.~JL..~D. fi~l. .......................................................................................... ~ · ..................................................... ~o~ ........................................................................................ ~ ..... pumu~qt to application dated ........................... ~p.~ ..... ~¢ ......... , 19...~, and 'approved b~ the ~5~i '. Building In,e~or. ;&%% ................. ~ ................. :,~ ~;- Building In~ector FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............. Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/~~ .............. ~ ............................................. (Bm'lding Inspector) APPLICATION FOR BUILDING FERMIT INSTRUCTIONS Application No ...... ...~....~....~....~. · ........ a. Th~s application must be completely filled in by typewriter o¢ 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 ~ areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatiot c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Such perm 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 Occupanc shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the msuance of a Building Permit pursuant to th Building 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 applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ~ (S~gnoture of applicont, ord~me, if a corporation) (Address of applican~i '"'// ................... State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises ../~..~ ..... .~.,.....~......~.....~..'~.../.~..~.. .......... ./.../.~..~.?..?....x~.. ........................................... 2. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~.~ ..... ;; ..... Plumber's License No ................................................. Electrician's L~cense No ............................................. Other Trade's License No ............................................... ..~. ~ Locahon of land on whmh proposed, work will be done Map No ............ ,, ................. Lot No .............. .............. ....... ............................................... Street and Number Municipality a Exis~ting use and occupancy ....... .vz~...;.z.~..~- ............ \ ......................................................................................... b Intended use and occupancy .................... .[..! ................... ~'~-z"~- "-~__~.~~.....~.....~....~--//'~/ ................ 3 Nature of work (check which applicable). New BuiIfl~ng ............. Addition ................. Alteration .......... Repair .................. Removal ................ Demoht,or ............. Other Work .~....~?~-....~..'~ -- .~/.~....~ ......... (Description) ,t Est, mated Cost ............................................................ Fee ...~?~ (to be po~d on filing th~s application) 5 it dwelhng, number of dwelling umts .......... ~....Number of dwelhng umts 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 D~mens~ons of ex,stag structures, if any. Front .......................... Rear ................................Depth ................... Height ........................ Number of Stories ...................................................................................................... Dm~ensions of same structure with alterahons or addmons. Front .................................... Rear ............ DaF,th ............................. Height ...................... Number of Stones ............................. 8 Dimensions of entire new construchon' Front .................. , ................ Rear ............................ Depth ............ Height ................ Number of Stones ................................................................................................. 9. Size of lot Front ........................................................ Rear ...................................... Depth ........................... 10. Date of Purchase .................................................... Name of Former Owner ..................................................... 11 Zone or use d~stnct in which premises are situated ............................................................................................. 12 Does proposed construction wolate any zonmg law, ordmonce or regulahon ........................................................ 13. WHI 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 ..................... Na He of Contractor ...........................................Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dlstmctly all buHdmgs, whether existing or proposed, and indicate all set-back d~mens~ons fror property hnes Gwe street and block number or descnphon accordmg to deed, and show street names and in&cat whether mtenor or corner lot STATE OF NEW YORK, COUNTY OF ...$g~;~.O.:~ ............. f ~.a ............... 1~.l:'.lD~z:::~. [-Ia.z:~'.:J.D.g~brt ........................... bemg duly sworn, deposes and says that he ~s the opphcor (Name of individual s~gning contrac'~) above named S He ~s the .............................. Q.~'t2-..~. ............................................................................................................. (Contractor, agent, corporate officer, otc ) of said owner or owners, ond is duly authorized to perform or have performed the sa~d work and to make and fil this applicahon, that all statements contained in this apphcahon are true to the best of his knowledge and belief, an that the work wdl be performed m the manner set forth m the apphcat~on filed therewith Sworn to before me th~s ........ 2.4...~.b ...... day of ....... .~.e~..e.~.e. rs ff lk ......... , 19. 76~~-~ .................... Notary Pubhc, . ....... ~ .................. ....q~.~...o...... ..... County (Signature of a~'plicant) ELIZABE1FH ANN NEVILLE NO'TARY PUBUC SlaTe o! ~qew York No 52 8125850, Sullolk CouFJ~Y Term Expires I~arch 30.