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Home My WebLink About8522-z FOB3E NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8522 Z Date ....................... ~.pr'$']~ ....... '2~ .......... 19..~._~.. Permission is hereby granted to: C~.~P-~e]~ ..~'.~.ng~ ~'...J~...6...,~.:L.f e ...................... ................... t:~'t'"~v~ry"ave .......... P~trhogue to ..e.~e e~c..~..~t~frzz..f~nc~g..~ s..v~ez,..ap, pl.I~utToz~ .................................................. at premises Iocoted at *.**~/~.*~t.'lk*.*l,v~l~ ...................................................................................... .................................................... Cutc~o~ue ...... l~,~., ...................................................................... pursuant to application doted ............................ ~),]~.1~,.....J..br......, 1~)..~., and approved by the Building Inspector. Fee $...1.~..Q0 .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~.....~.... ....... , 19.~..~. Approved ................... !.: ...... .,~....~..., ]9..~...~,. ~rmit No...~.....~......'~......~..".~ DLsepproved a/c ...... ......................,~.................~.................. ...................... ---~----~ Application No. ~ ~ ~ INSTRUCTIONS Date .................................. , !~..6. ....... ~' 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, 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 oz areas, and giving a detailed description of layout ofproparty 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 Occu~xlncy shall have been granted by the Building Inspector. e .A,P,.PLI ~CATIO~N ,!S HEREB. Y MADE to the Building Department for the issuance of a Building Permit pu.rsu~,.nt to the u,a~ng Lone ~Jra~nance ot 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 ragulotJons, and to admit authorized inspectors on premises and in buildings for necessary JnspectJo~lS. (Signature of applicont,~'nam~, if a corporation) (Address of applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ................................ Name of owner of premises .....~....-~..../~...~. ....... ~---..~..--~-.~..-.~/A~ ................................................. If 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 ............................................. Iooo- 09 7-I ¥ Other Trade's License No ................... ' ........................... i. Location of land on which p .rpposed' work will be done. M~p No.: ...:~ ....... ~....i ..................... Lot No. ........................ Street and Number .~..~..~...~.l~,..~.....~.:...ff:~Z~...~./C~..~.. ~,,.,.3~L.~..~..., / 2. State existing use and occupancy of premises and intended use and occupancy of proposed c(mstruc~on: a. ~xisiting use and occop~ncy ..~t.~_~r~'... .1'.~. .~.£..¢ ............................................................................ b. Intended use ond occuponcy ....',~,~'~.....~......../~~..~ .................................................................... 3 Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal ............. ..... Demolitio~ .................... Other Work ...... ~..~.~. ............................ (Description) ........ . ............. ................................................................. 4. Estimated Cast ........... .' .......................... 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 ~ ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if 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 ~onstruction: Front .................................... ~ear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ I0. Date of Purchase ~.~....~.].~ ..................... N~me Of For~er ~ner ..~.~.¢.~..~,....~!..~.~ .......... 1 1. Zone or u=e district in which premises are situated ....~.~.~.~.~ .................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will tot be regraded . ........................... Will excess fill be removed from p~emises: ~ ) Yes ( ) 14. b, ame of ~,er of prem,ses ........................... ~ ....................... Address ....~~.~;f Ph~e Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~ck dimensions from prop~y lines. Give street and block number or description according to deed, and shaw street names and indicate whether interior or corner lot. STATE OF NEW/~ORI~, ~I IS S ~ ~ COUNTY OF .~" ~.~L/.~;..[.-./...~..J~.~,, .~.. ~'~ . be ng du y sworn, deposes and says t~t-~ is the aPplicanl (Name of individual signing contracf) above named. ~ He is the .................. ~.~.J~.~.~. ..................................................................................................................................... (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 that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ ~ Nato, Pubhc, ... ~~',,.~. ,', ~ ,- (Signat~of applicant) Notory ~~ ~ C~mm. E:kmrcs f~%r~l au, .