The URL can be used to link to this page

Home My WebLink About8885-z FORM NO. ~- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8885 Z Date .......................... .~..e. ~..~. ..... .2.?. ........... , 19.7..6.... Permission is hereby granted to: Daniel T & G. Herbert Smith Southold Build new one family dwelling -~ = Southold * L~. '-~,.~,~>.p~ ' ~ ' ' AU~ 08 76, rsuant to o phcohon dot~ ................................................ 19 and approved by the Approved ............................. ~.. ......... IvOR, M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~....~...~...~. ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date..~....,~...~... .............. 19.~. ~,,~. a. This application must be completely filled in by typewriter or' m ink and submitted in triplicate to the 8uildin.~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buddings on premises, relationship to adjoining prem,ses or pubhc streets o, 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 apphcation may not be commenced before issuance of Building Permm d. Upon approval of this application, the Building Inspector will ~ssue 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 o Certificate of Occupanc~ 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulahons, for the construction of buildings, additions or alterations, 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. State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder: Nome of owner of premises ..~~/..~.'.....~,~.. ,~..~~~.. If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate ofhcer) Builder's bcense No ..................................................... P umber's Ucense No ........ .................. Electrician s License No .... /.;...~ ................ Other Trade's L~cense No ............................................... Location of land on w__hjch proposed work will be done. Map No. /f~.IM~A~...$.~.~I. ........... Lot No .... .~.. .............. Street and Numbe~J~/~/'~.T.//.../~)...]Tr~...,~,~l~..~(./2. t.~./~. .............. ~'~.¢~'..~./ff.~..~..~. ~. ....................... / / -- /r~unicipality State existing use and occupancy of premises and in*.ended use and occupancy of proposed construction: o Exlsitlng use and occupancy ........ ~...~.,~.~..~.. b Intended use and occupancy ............ ~.~.4~,,~,~.~.~.~, ................................................................................ .I :3. Nature of work (check which apphcable) New Building .. j/ .......... Addition ................ AlteraHon .......... Rep~ur ................ Removal ............... Demoht~or .............. Other Work .................................... 4 Estimated Cost ..~..,~.t9..o..?. ...................................... Fee ..... (to be pa;~'on fihng this '~t~i;~'t,~'i ....... 5 If d,velling, number of dwelhng units ...... ~, ............ Number of dwelhng umts on each floor ...................... If go, rage, 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, ~f any' Front ........................ Rear ................................Depth ................. Height ........................ Number of Star,es .................................................................................................... D~mens~ons of same structure with alterations or additions: Front .................................. Rear .................. Depth ................................Height ....................... Number of Stones ............................ 8 Dimensions of ent,re new construct,on Front .~'~..~. ...................... Rear ....~...~....~ ................ Depth ....~.~...' ........... Height .. ~,,~'Z..¢ .... Number of Stories ..... ~r.,4/.~, .............................................. 9 S~ze of lot. Front ,~.~..~.....~....G...~...~..~.~...~.. .............. Rear ........................................ Depth ............................. 10 Date of Purchase ........................................... Name of Former Owner ...................................................... t 1 Zone or use district in which premises are s~tuated . .~..~.Z'4~..~. ~.~- ......................................................... 12 Does proposed construction violate any Tatung law, ordinance or regulation ...~..~ .............................................. 13 WHI lot be regraded ....................... WHI excess fill be removed from premises ( ) Yes ( ) No 14 Name of Owner of premises ..~;Z~.,,~..~.~.~.....,,C'.n...~..f.?.../f. ............ Address .....~'...~...~....~.(.~..."..~..~.. ...... Phone No ....................... Name of Archftect . .. ,~../~.,.,~ -. ......................... Address ................................Phone No ....................... Name of Contractor ................................................. Address ................................Phone No ....................... PLOT DIAGRAM Locate dearly and d~stinctly all buildings, whether ex,sting or proposed, and md~cate all set-back dimensions from property hues Give street and block number or descr,phon according to deed, and show street names and indicate whether interior or corner ,/ STATE OF NEW YORt<. ~ S S COUNTY OF ...... ~.9. ~ EO.~C, ...... f ......... ~..."~..:~r~ ................ being duly sworn, deposes and says that he ~s the opphcam (Name of ~nd~wdual s~gnmg contract) above named He ~s the ....... ~../,~./~/~..4~ ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this application; that oil statements contained ~n this application are true to the best of h~s knowledge and behef, and that the work wdl be performed in the manner set forth in the apphcat~on filed therewith. Sworn to betore me this .......... .2.'/..t,~ ..... day of .~.~t..e~'o~:: ................. , 19..~6 Nota~ Public,. .................... ~L~ ............. Coun~ (Signature of applicant) -{ h4 / hlO~ ° ~joHH