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Home My WebLink About8628-z FOI~M NO. ~ TOWN 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? 8628 Z Permission is hereby granted to: at premises located at ...i~'q~.l~,..]~l~ .................. ; .................. ~ .................... : ......... ......................... ..... :i ................ ~ ............................. ~t,~t--~....~-~.-.~ ................................................. : ................ pursuant to application dated ......... - Buildipg Inspector. opproyed by the Building In~"~ctori t ' TOWN Of S(X)THOLD IUILDIN4 DEPARTMINT SOUTHOLD, N. Y. Exomined .........~ ~ 19...~,.~ Alspraved .... ~ ......... ' '9 ~ I~rm,t No. ~ ~ ~ Di~:~rov~ a/¢ .................................................. : .......... Application No ..... ~.~ ...................... ~tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typeWriter oe 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 odjoining premises or public streets or areos, and giving a detailed description of layout ofpraperty 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 appl!cation, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avadable 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances 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. .............. ....... .......... ~atu.~e of applicant, or name, ifa cor~('ration) .............. 4: ......... '../.. .......... ,~. ........... ~..~..........~: ........ _ · .-~ (Address of applicon, t) State whether applicant i~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'V Name of owner of premises . .2~._ If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Bu,der's L~c.-se 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. AAop No.: .........................~.~:...~......Lot No, .-; .................... Street and Number ~'7 ~ /~ 7~/~ ~... //...~. ~/~ - C ~--z~- ' .~....~, * ...................................................................... ~."Z'~;~Z;;;'~:~'~ ...... '~;;;i~'i'g;ii~ ........ State existing use and occupancy of premises and intended use and occupancy c~/propased construction: o. Exisiting use and occupancy ............... ~../~../'.....~........~..~...~.. ....... ...~.~...~..,.~....~..~.~..~...~ ......................... ,. ,,: b. Intended use and occupancy ...................... - ........... ..................................................../'~'~-~'"~'~'~'"'"~' ............ 3. Nature of work (check which applicable): New Building. Addition Alteration ............... Repair Removal Demolition .................... Other Work : ~,,~/,,,,~.,.~. (Description) 4. Estimated Cost 0 Fee ...L~..~ ................................................. ! ..................... .......................................................... (to be paid on filing this applicotidn) 5. If dwelling, number of dwelling units / Number of dwelling units on each floor If garage, number of c~rs ............................................ ~ ................................................................................................ 6. If bus[ness, commercial or mixed occupancy, specify.nature and extent or,ach type of use .............. ~., ........... 7. Dim~j~sions of existing structures, if any: Front ........~....~. ............... Rear ....... ~ ........ ............. Depth .......'~....~.. ....... / Height :~ ...................... Number of Stories ................................................................................................................ DimenSions of same structure with alterations or additions: Front ~ j'o Rear Depth ................................ Height ....... ..................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... : ...... ./...~. ................... Rear ....... ../...~. ............... Depth ...... ./....~.. ........... /o Height .................... Number of Stories ..~ .........( ........................................... ._- ........................................................... 9. Size of lot: Front i ............/..-~.,.~....;..~../. ......................... Rear ....... /...~..~.;.~.~.....~... ............. Depth .....Z~...~..'.'.~.../.. ........... D // ~/ 7 f F er net ~'~J~*~::- 10. Date of Purchase / 7.~.. Name o arm Ow · 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................... ~/~"~¢'t~'~: ............... 13. Will lot be ;egraded ..........~.....~. ............ Will exce~ fill be removed from premis_e~: (') '(f~/ ( ) .No (':~/~ 14. ~'~ame o~ uwner aT premises ......................................... l ......... ~re,~ ............................... , No ....................... Name of Architect .............................................................. Address ................ : ............... Phon~e No ...................... Name of Contractor .......................................................... "Address .............. ;....'. ............ Phone No ....................... PLOT DIAGEAM Locate clearly, and distinctly all buildings, whether existing or proposed, end indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. /6 STATE OF NE'M/ YORK, ~ ¢ S COUNTY OF ....... ~ ........ ~' " ..................... · ~-II~..~,,...l~l~ .............................................. being duly sworn, deposes and says that he is the applicam (N"o~"~-~F rnc'liv~o~l signing contracf) above named. He is the ................................. ~ .................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfOr~n 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 perform~ in the manner set forth in the application filed therewith. Sworn t~ before me this ( ) ,, ~ ~ .......... ..... dayof.... ...... : .......... [ ) . · ~ ~ (Signo~ature cf aDolicure o app ican~)~~~ ELIZABETH ANN NEVILLE NOTARY PUBLIC, State ~'New York No. 52-8,25850, Su,to~k Cop~y.