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Home My WebLink About8612-zTOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8612 Z Permission is hereby granted(to: ...,/~ ..&..~m~ .... a~a,~ ........................ at premises located at ..~]{[q~...,~h,.~l~-;J~l,..~3~lt~:..~ ........... : ........... ;.:..: ...... : ......... ~ .............. ....................................... : .................... ~1~ ........................................ ...'",~ ........ . ....... "': .............. pursuant to application dated ........................... ~.....~JS. ............ 19...~.6, a~d app,roved by the Building Inspector. Fee $..].~:~(~ ........... I~OP~M NO. l TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .............. Application No .............................. INSTRU~IONS ~ a. This application must be completely filled in by ~pewriter o¢ in ink and submitted in triplicate to the B 'Id' g Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and o~ buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving ~ detailed description o~ layout ofproper~ must be drawn on the diagram which is pa~ o~ this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval o~ this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shell be occupied or used in whole or in part {or any purpose whatever until a Ce~fficate o~ ~cupancy~ she~l 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 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 in~tions. (S~;}~atu,re 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. #- .............. .............................................................................................................................................................. .ome of owner of premises ...~..~..~....~/.......~.......~..../~...~/..~' .~.,../..~'.....~.*.....(..~..~'..~../~.Z~.. .................................................... If applicant is o 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 ............................... .'.""~"~r~' Mo No Lot N 1 Location of land on which proposed/worJ~vi b · P_, .: ...........;, .................................................... Street and Number//(,~......,4~...f~g4.~...~../..J;~./~..-../C-~.........,..''~f..~..~rS..~.~.~. -*~,.~... ......................................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Ex,s,ting use and occupancy ................. b. Intended use and occupancy ........... ~~"~'7' ........................................................................ // // / / · 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demo ton .......... Other Work .. .~.,....-~..~-. ................... i ,De, cript,on) 4. Estimated Cost ._~__~. ............................................. 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 ............................................................................................................................................. fi. 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... _-- - .Number of Stories ..................................................................................................................... 9. Size of lot: Front ..Z~'...~..~ ........................................ Rear ..... /..~.,~.....: ......... ..~ ........ Depth~:.,~..../.~...:. ................ Dote of Purchase/ './~'~.. Name of Former Owner~.~./~.~...~../.~'.t~.....(~.~..-~....~..~.'~.. 10 .......... ...... .7., ................................................. 1 1. Zone or use district in which premises ore situated .................................................................................................... 12. Does proposed construction violete any zoning law, ordinence or regulation: .~...~. ................................................. 13. Will lot be regroded' . ........................... Willexcess fill be removed from pre~ise~s: ( ) Yes ( ) No 14. Name~f~wner~fpremises~..~./Z~...~..~.(~'~.~.~.~..~...~z.~.~.Address/~'~'/~.~'~Ph~n"N~7~~~ Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. II _C'FATE OF NEW YORK, lc c COUNTY OF .... ~t~'o.l~ ..........f~'~ ............................ ~o]az't..~:l;;z'.au.~ ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................. o.~r~'. ........................................................................................................................ (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; 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.__ Sworr, to before me this ........ 2.8.t[0. ...... day of ................ ~a~. .................... , 19...7.6. I Publle,. .......................... ....... ............... ................................ ~~~~ /// (Signature of applicant) ELIZABETH ANN N£VILLE NOTARY PUBLIC, State of New York Ng §2-8L25850, Suffolk Term Expires March 30, 19_/