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Home My WebLink About8636-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8636 Z Permission is hereby granted to: . ,i L ' · ......................... :.,.o.~.~.~ .................. ................. at premises located at ...~.J]..J~.,J~.~t~L ................................................................................... · .. o~ent~ ..................... - ...................................................... pursuant to application dated . ,. ;,~,.~'~,",;~ ~0 19,~,, cm approved by the , Buddtng Inspector ~ ' Building Inspector. Fee $ ........................ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ;?,.~,,. , SOUTHOLD, N. Yo Exam,ned ........ Approved ...... i.~.)/.. ........ :: ...... ./.,!?...., ,9.Z/,.2, P, rmit No. Disapprove~... -/"a/c .. ~,,- ........................... L_,./'~'""-*'"'~'~"~"~'~ ............... ..................................................................... ................... ................. / ' (Building Inspector) / APPLICATION FOR BUILDING PI~RMIT Dote .................... ~*T~IJ~ ......~ O ........ 19..~/~ ...... INSTRUCTIONS o. This application must be completely filled in by typewriter of in ink and submitted ig 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 adioining premises or public streets or areas, and giving a detailed description of layout of property 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 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 a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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. ........................................................... ,C.~r~t~'&C ~r. ................................................................ : .............................................. Name of owner of premises .~..~.~.~.~....~,l~t,:~.~J~ ............................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....g...,~,...~:..-g. .................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... i. Location of land on which proposed work will be done. Mop No.: ............. ~ ...................... Lot No ...... ~,~ .............. Street and Number ........ ~.,,K~..~.~ .......... 01t~e~t,....~..~%, .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....~.?.,?.~.]'.,.~.~ .......................................................................................................... b. Intended use and occupancy .......... ~l,,~.~..,1~J.~.~j~..~j~.~J'l.~ ............................................................................. 3. Nature of work (check which opplicab}e): New Building.. ................. Addition .................. Alteration ............... 4. Estimated Cost ............................................................ Fee 1 (to be paid on filing this application) 5. If dwelling, number of dweliing 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, Jf any: Front ............................ Rear ................................ Depth .................. Height ........................ Number of Stories ......................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear .................. , ......... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ................... ; ........ Depth ........................ Height .................... Number o~f Stories ..................................................................................................................... 9. Size of lot: F'ront ....... h' ............................................... Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ...!,tii..l.t...a.:Lsg .............................................................................. ]2. Does proposed construction via[ate any zoning Iow, ordinance or regulation: .... Z[O ............................................... 13. WiiI lot be regroded . ....... ..~...O. .............. Will excess fill be removed from premises: ( ) Yes ( ) No .] 4. Nome of Owner of premises ....]~.,,..Ga,g~,.~.&~ ..................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No No'me of Contractor ..........0..~..&..C. ................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate ~roperty lines. Give street and block number hether interior or corner lot. STA-I'E OF NEW ¥ORI<, / S.S COUNTY OF ....... ~/t£~:1~, ........f ................................. ~..~.~ ................................... being duly sworn, deposes and says thor he is the opplicanl (Name of individual signing contracf) above named. He is the ............................................. ~.~P~ ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all stotements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to beforej.0doy ofme this ~ ~~~~ -- Notary Public, . ................................................... Coun~ ~~.~..// ....... ~~.~ ................ ~ ' ~ (Sig~t~ppli~nt)