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Home My WebLink About8537-z FO]~M NO. ~ TOWN OF SOU?HOLD BUILDING DE~A~T~t~I~T TOWN CL~R~,S'Ome~ SOUT~LD, N~. Y.~: i BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON COMPLETION OF THE WORK AUTHORIZED)' Permission is hereby granted to: /?, ,, · Tw~..F.o~-~...;~.e~ a...C*.. AJC..-.. ~ a~e~.Nako ~ ~ ' ~ .............. ~-~ue~ ........... : ....... ~,....:~:..:.:.:., ...... :~ : "t p ~ .... ' .~. ' car "~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. praved ............................ e m,t No. ........... ' (Building Inspctor) APPLICATION FOE BUILDING PERMIT INSTRUCTIONS Application No...~.....-~...~.....~. .............. a, This application must be completely filled in by typewriter or 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 o~ areas, and giving a detailed description of layout of property 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 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 have been granted by the Building inspector. APPL CAT ON S HEREBY MA. DE 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 Regu at ohs for the construction ?f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply wrth a applicab e laws, ordinances, building code, housing code, and regu aligns, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~../~.~ ~....-Z..~.~:~..:;;.~ ........... ~:;~ ........... (Signature of applicant, or name, if o corporation) ............. .... ~ -- (Address at oppHcant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ......................... ~,.~~.~, ...~...~ ............................................................................................................................. Nome of owner of premises ............ ..~./t~,.~,...~., ,.~,.. ~,..,~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and titte of corporate officer)/ Builder s Liconse No .................. "~'~ ......... Plumber s License No ................................................ Electrician's License No ............................................. ........ , ...................................... Location of land on which proposed work_will be done M2p l)l~.: .~-'.Z.~-..-~. .......... Lot No..; ...................... Street and Number ....... .~.,2~........~'~'~-.-~.'7~.~4..:..~;'...~.-.~.' ............v.?..~.~..~,.~..,~.~.~,.,..~.~. ................... Municipality State existing use and occupancy of premises and intended use amd occupancy Of proposed construction: o. E×~siting use ondoccuponcy ........... ~.~.....:;Z:/~:Z:~:,,,.~.~::~..f. ....... ./.X.~. .............. b. Intended use and occupancy ................... :.:.....'""'....,.'.' ........ ...L./... ............... 3. Nature of work (check which applicable): New BuiMing,. ................. Addition .................. Alteration ................ Repair .................. Removal_ ,~, /' .................. Demolitior, .................... Other Work ...... 7// ......... i~'~';il~fi~ ......... 4. Estimated Cost .................. .~..~.~.....~ ....................... Wee ........................ /....O..Z.Z. ................................................... (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, 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 of Stories ...................................................................................................................... ' 9.,~Size of lot: Front .......... ./../...'~.'~.. ................................. Rear ................................. Depth .~..~....O.. ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13, Will lot be regraded , ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14, I'~ame of Owner of premises~:~.....~..'...(....c..~.....(=~:..'~,.'., ,C~-- ................. Address . ~....~,...~.z~..: ......... Phon~ Name of Architect .............................................................. Address ................................ Phone No ............ ' ........... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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 whether interior or corner lot. STATE OF NEW¥ORK .,~ / ~¢( COUp/ .... ;/...,..~,~,.~ .................................... being duly sworn, deposes and says th~3t he is the opplicam (Name of mdw~dual s~gnmg contractO above named. He is the ................................... ,.C-,'.~;;:~~2~,Z~...~..,..~.. ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make end file this application; that all statements contained in this application are true to the best of his knowledge end:belief; and thru' the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ., ~ ~ .,~ ...... day of ........... ................. , /_,d /Y Noto ub,c,. ................................ FZ.,.Z/r'Coun ............................ / (~gnature of applicant)