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Home My WebLink About8642-zTOWN OF SOUT~HOLD 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) Ne 8642 Z Permission is hereby granted to: ..lI;,...~a~.~...; ........... ~ ......... ........... .....i ..... ........ ,. ........ ~t..;i~.~..i~l ....... Ii~.!.~..~.~ ..... ,, to..~ee~ .a.. ~.t.n~.~.~,..~;~.~..~.~ ~.en~.~,'kj ~a ~. ~a.~n ....... at premises located at ..~..t ~...~., '~8 ~.~l,~.~::!~.,.~..~,~i]~...; ...........:.....:...;.. '; ................ pursuant to application dated ..................... ~ .1~.~.....~[~ ...... ; ....... , 19.,.~/,ij[f an8 approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No ..................................... Application No ................................. Disapproved cdc .~;....-r:::. ..................... ~,,':T.. ................ A~PL~CAT~o~q ~OR SU~LJ~Jt~G I NSqRUCTIONS, a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, aocurate 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 o~ areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this <~pplication, 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 port for any purpose whatever until (~ 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 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 necessaW inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) j t ~7 ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... 'fT'. ......... .................................................................................. Name of owner of premises .................................................................................................................................................... Jf 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 ............................................... (x~//q ~%/'~ (_/ t-~--~'' ~ 7 ':~ -t ]. Loc~tion of Iond on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ,-.~/ ,v ~'?,~/~%/'"L/ ('~,)/~dT' L~L) ~(.l '-7r' /It~'~)l~.~ ............. ~"r~:"y"~ .............. ' ........................................................ I ............................................... Municipality 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...................(:'..!,~.!,1,: ........... /!'./.~..!..~.,.'...':..'.!: .............. ~?.,..~..]..,.: ....................................... b. Intended use and occupancy -~f~ f'~ L' ~,~uT F~ I' L: I~.J(" t::- 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ............... L' IV Repair .................. Removal .................. Demolitior ..................... Other Work o ~ (Description) 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 ............................................................................................................................................. 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions o¢ same 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 ................. c~.~:~!..O.....~ ..................... Rear .......................................... Depth 10. Dote of Purchase ........................................................Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ~\ ~ -~ z 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ~..(.! .............................. 13, Will lot be regraded . ........... [,~."~_!! ....... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ............. - ....................................... ,~aaress ................................ Phone No./ ~' .... ~. .......... Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor ....................................... : .................. Address ................................Phone No ....................... PLOT DIAGRAM Locate cle~r}y and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from proporty lines, Give street and block number or description accarding~t~,.d, eed, and show street names and indicate whether interior or corner lot. ¢". ¢ ~ ~-' STATE OF NEW ~?O'R, IC. Tz,.~..~ f/4' / c c ................................................................................................ being duly sworn, deposes and soys 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 du(y 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th s , ...................... ~. day of ............................. Nota~ Public, . .................... ~: ................ ~..~,..,.... Coun~ ........................ ~.~;;.; ............... 7 ....... :; ..................................... ~;.~ _, ~, ~,~ ~ v ~ ~ ,~ ~ign~ture or appdcanf)