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Home My WebLink About8506-z FOBZ~ 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? 8506 Z Date ..................... &p.~-.1......1.6 ............. , 19..~. Permission is hereby granted to: ............ l,:~t~it~z~ ............................................. to ...~ui~d..~..a~ditiar~..on..exia~in~..dwe.1] 1~r~ ............................................................. at premises located at .......~.t~d~y...Roe~ .......... Lo.t;..~ ................ i ................................................... ....................................................... .:~,~t~.~,~.~,....~.,.~., ..................................................................... pursuant to application dated .................. A.p.~1.~.......1.~ ................ , ]9..~.~...., and approved by the Building Inspector. Fee $...1.~.~...0~... .......... Building ~nspecror ~ FOR,~'[ NO. ! TOWN OF SOUTHOLD BUILDING 'DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............... : .......... ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. 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 adjoining 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 wil~[ issue a Building Permit to the applicant. Such permit shall be kept on the premises availc~ble for inspection throughout t~e 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 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 a app icable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~ _ .~ ......... ~nature of applicon'( o-r ,~q,n~'e, Jfa corpor~';i~i ........ ....... ' ................. / (AdSress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ..................................................................................................................... Name of owner of premises ..%~1~....)~..~.~1~..~.~,.~..~,, ............................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ./...~,.~.....:...~.4..~,, ............. Plumber's License No. ,,,4,,,,~I-.~.;';..~..~.~;,~;"..~,~,~i,,~ Other Trode's Ucense No...~.~S,.~...-...l~.~..T.~v[o ¢- ..-~ ,~, ~. 1. Location of land on which proposed work will be done. /~op_No,: .~../....~..~..~..,.~.~..~,... Lot No ......................... Street and Number ~.~.~.~`~.~k~.~F~.~..~..~.~.)~`~:~..~.~`~;~ ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: / o. E×~s~t~ng use and occ~pa.cy ...~.~.~.~c....~.m.e.~ .......................................................................... b. I ntended use and occupancy ...~ ~......~.~L'.~'.....~T~ ~ ...... [..~....~....~....~,...~-d~.....0, ...~ ...................... ~3 Nature of work (check which applicable): New Building.. ................. Addition ....~....- ........ Alteration Repair. ................. Removal .................. Demolitior~ .................... Other Work .................................................. (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 ...... ~ .................Depfla ...~..L ..... Height ........................ Number of Stories ~ ~ ~..~ ....... ...................... ......................................... ................ Dimensions of same structure with alterations or ada' 'o : ant ..... ~ ....................... Rear ..~ ................... Depth .....~.~.~. ................ Height ............................ --/Number of Stories ......... [ ...................... 8. Dimensions of entire new construction: Front ........ I.~....~. .................. Rear ........ ~. ......... Depth ....~.~.." ........... Height .................... Number of Stories ......... [ ........................................................................................................... 9. Size of lot: Front ........ /~...~..~. .................................. Rear ..... ./.~.~..~ ...................... Depth ....Z~..~. .............. ~0. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... ~.l.~.e..~.~.~ ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~..~ ......................................... 13. Will lot be regraded .........~.~ ......... Will excess fill be removed from p~mises: ( ) Yes ( ) No , 14. Name of Owner of premises ...~.C.k.....~.~k~.... Address~[..~ Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor .~.,...~.~.~ ........................ Address ~E~....~.~ ...... Phone No. PL~T DIAGRAM Locc, te dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~bether interior or corner lot. ., ,~,. STATF OF NEX>~Y~_, ~.d" IS .$ COIJNTY OF ~~.....(:[' ......................... Z.~ ........... ~. .......................... being duly sworn, deposes and seys that he is the applicar,, (Nome of individual signing confracf) above named. He is the ......... ~..~~.~ ....................................................................................................................................... (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 ~his application; ~hai all statements contained in this applicction are true to ~he best of bis knowledge and belieF; tha~ ~he work will be performed in the manner set forth in the application filed therewith. Sworn to before this ~ / ~ Notory Public~ .....v..~.~....~ ..... ~ .....m.n ....... ~Coun~ ............. ~......~.~ ............................ ' ~ ~ / ' (Signa~ of op~cont) '~OTA~Y pUBLIC, S~{e o{ ~ew Yor~ No 52.57i2~00 '~ali~ie~ in S.ffolk County ~erm Expires Mar~h ~0,