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Home My WebLink About8910-zTOWN OF SOUTHOI~D : BUILDING 'DEPARTMENT: TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO, MPLETION OF THE WORK AUTHORIZED) 8910 Z Permission is hereby granted to: ..~z~..~l~ ................................................... ........... ~o~..~2~ ....... Y~at~l~k ...................... at premises located at ..~..Y.~...~.I~,.~...(.~).~..~.~7;:-.-]~). ........................................................................ ............................................... ~Lf~...:~.b...~..~.~..~ ........ ~a.t.~l~,~k.....~.,.~.,. .................................... pursuant to application dated .......................,~.....-~.~. ............... , 19,.~.~., and approved by the Building Inspector. [Zee $..3.0,,?0,O. ......... Building Inspector " '' ~ TOW~_OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... .~,..~. ............................ 19 ........ Approved .... ~ .......... Z..,m).. ......... , ........ Permit No .................................. ~...~..~ Application No......~...Z./.?...~.--7.. ...... Disapproved a/c ............................................................ ~ ......................... ~.~__- -~, ....... ' (Bui~'ng Inspector) ~ APPLICATION FOR BgiLDING PERMIT/ ~. ,~. Date/. ....... .................. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 az 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 application may not be commenced before issuance of Building Permit. d. Upon approval o1: this application, the Building Inspector will issue a Building Permit to the applicant. Such permit 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or aHerations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporatian) (Address of applicant) State whether applicant' is owner, lessee, agent', architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ...~..~ ........... ~ ................................................................................................................... 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 License No ............................................. Other Trode's License No ............................................... Location of land on which proposed work w~ll be done. Map No.: .!~.~.z~.~.~'..~,:~.~i\..~.~.~q~. Lot No ........... .~ ............ Municipality State existing use and occupancy of premises and m,endea use and occupancy of proposed construction: e. Exisiting use and occuponcy ......... ~>3... ~.~..~:~,~ ....................................................................................................... b, Intendec use and occupancy 5r..~.~ [~,~ .[i,~,~.' ?~,~m~ '~) ~4~)'.~k.~.'~.:& ............-J i ...... - ~ 0 ~ '~ ~ ~ ' .......... Demot'it on .................... Other Work Repair ~'~" Removal ...... ~ ....... ' ~ ' ~'~-~'~ (Description) 4. Estimated Cast ............~.~.~..~.. ..................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ..~:..?..~...~.. ........ Number of dwelling units on each floor ....~..~..~..~ - ........... If garage, number of cars .......................... ..~.,~h.~..?~. .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...=.~..2 .................. 7. Dimensions of existing structures, if any: Front 4r'~'O*~ Rear ...... .~,~..O .................. Depth .~...~ ...... ~.. Height ....... .~..~ ............ Number of Stories ......... ~, .......................................................................................... ~'. .......... Dimensions of some structure with alterations or additions: Front ...... 0.,..~...~,~D,..,; ....... Rear ............................ Depth .............. ~ ............. Height ............................ Number of Stories ...... ...~..L .................... 8, Dimensions of entire new construction: Front ............. ~ ..................... Rear ..... .tL~.~,.' ................. Depth ..~,.~, ............... Height ........ .~..~. ........ Number of Stories ....... ~--,~ ........................................................................................................... 9. Size of lot: Front ...................~,,~.%.2, ........................... Rear ..... ~.~...L.2:..~..". ..................... Depth 10. Date of Purchase ........ .t.~,:~.;.~.~,,r~.q,..~.~- ...................... Nome of Former Owner ...~:~.-~.~:..~..~.~.~ ............................... 1 1. Zone or use district in which premises are situated ......................... .~......~.~-,~.~.~,~..~.~ ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~..c,. ............................................. 13. Will lot be regraded ......~.~.~ ................ Wilt excess fill be removed from premises: ( ) Yes ( ~No 14. Name of Owner of premises ..... ..~...~'~...~....~...~.~D. ................... Address ..~..0%..~.~. ~.;~?t4X~.~..~.~.~Phone No.....~. ................ Name of Architect .................~.'~-.t.~. .....................Address .....~......L~ ........ }~ ........ Phone No.....~..;,.~..'. .......... ............... Nome of Contractor ............ .~ .. Address ................................ Phone No......-~.. ............... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or coraer lot. N STATE OF NEW YORK, COUNTY OF ................................ ~ '~"~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (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 file this application; Yhat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to_before me this ~ ' ..... ...... doy ..... ............... , Noto Pub,c,. ..... ....... ..................... .................................... FP'AOE~R -- - (Signature of applicant) ~/OHN NOTARY PUBLIC, State of New York No. 43-4521780 Qualified in Richmond Yerrn Expires March ?30, -- t