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Home My WebLink About9047-z FORI!~ NO. l TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9047 Z Permission is hereby granted to: ~...q.h.n....~. :... ~.n...~..!.l.!. ............................................. ..................... ~3 9.Q.... M~.ba.~ sa,. $.~ .......... i~.O. ll ~ho!d at premises located at ..,,~a.,b.a.,~..s..°....~.t;., ................................................................................................ ................................................. go~thalrl ....... N.. ¥.. ........................................................................... pursuant to application dated .......................... ~..e..~......~..~. ............. , 19..~.?.., and approved by the Building Inspector. Building Inspector 1~0~ NO, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ........~ ........ ~. ................... , 19- . ........................................ , 19 ...... ;. Permit No ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 a~Jjoining premises or public streets or areas, end 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 of this application, the Building Inspector will ssue 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 a Certificate of Occupancy shall hove 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 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 to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ ....................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o p emmes ..................................... ...................... ~ ............. t, ................................................................... 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 Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ...... ~..~. ........... Street and Number ..... ~.~...~........~.....~...'~..~..:-z..~...C~........~....'~.. .................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... .L.~....Q..~..\.~ .................................................................................................. b. Intended use and occupancy ........... ..~....0..O..~.......~;...~.~....L~.. ............................................................................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~ D a U ,¢4.) / '~' FJ-o (Description) .; Estimated Cost .............. ......... ~J .................................... Fee ..r........' ............................................................................... (to be paid on filing this application) 5. If dweJiiog, number of dwelling units ............................ Number of dwelling units 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. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Fleight ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ........... ~ ........ . ............... Rear ........ t...°. ............... Depth ...... 7...i ............ Height ........ z .......... Number of Stories .................................................................................................................... 9. Size of lot: Fronl ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ NomeAof Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ...l~....q ........................................ 13. Will lot be regroded ....... .~....~. ............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises .~.?.!?..~..i~......!.~..t...d...~.k...c~...l ...... Address'5..~.'~....~..'..~.~...~/~r~.~.OPhone Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate ail set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or orner Jot. ~ ~_ CT<---[__ STATE OF N~ )'~Rl(,, i IS S COUNTY O,K~/*,~,~'. .............. f ' .............. .~.~.. ~...i..~...'....1~7... ! .g..~'~...~....u~...[ ............................... being (Name of individual signing contract0 above named. duly sworn, deposes and soys that he is the oppHcam He is the ................................. ~...u~.,...~....~-.......~m'. ...................................................................................................................... {Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn ~pl~,/~e.-~z~, me~hi~~ 19 ~Z ........ ....... ........... .,....., ....... , . No. cou. ................... ............. of