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Home My WebLink About8561-z FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) N? 8561 Z Permission is hereby granted to: ,~uf,~e..;~.o~.t,o~..~,..,;~n~...~.~e...A/C..Roht. Lawrence & Wife ........... ~{~ ~ .. S.tl. f.~..Q .3~ .......................................... to ..~.~ J./.~..~ ~...&~ C.~ ~ ~Qr~. ............................................................................................................ at premises located at .]~O.t..~; ........... .~s3~.~/.qg.~,..~.~l~ ...................................................................... ............................................... J~a.s.tw~o~..]L~m~..(... ~l,g ...~le e.t ..l.e c.k.....Cut;~,~.~&'tm,. .............. pursuant to application dated .......................... ~,a.~....k~ ................ 19..74~., and approved by the Building In~ector. Fee $ ...']..0..~,..0..0.. ......... L/ / /' Building Inspector/ TOWN OF SOUTHOLD B~UdI-DII~G DEPARTMENT ~'OW~l ~CLERK'S OFFICE SOUTHOLD, N. Y. ::::::::::::::::::::: proved i. ermit Disapproved a/c .......................... :~:~ ........................... ~% ...~ ............................. ..~.......~~ ........ (B~ildi~ ~p~r) 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 bf lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty 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 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, aw.~,?,rd!.ee.-.ce_% bu!!d!."-g :ode, hou~n(,) code, and regulations, and to admit authorized inspectors on premises and in bu~ dir[g~co{' necessary inspections. (Signot,,/re of applicant, < name, ff o corporation) State whether applicant is owner, lessee, agent, or{ itect, en§ineer, genera[ contractor, el, ~(ricion, plumber or builder. If Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ................................................ 1. Location of land on which proposed work will be done. Map No.: ......... ~.~.~:.~...~. -~¥~....~d~.~, .,~ Street and Number ................................................................................................................................................... ~'~ ~"'x Municipality 2. State existing use and occupancy of premises and intended use and occu'p~,~f proposed construction: Exisiting use and occupancy ............... ; ............................. ..~ ............................................................................... Intended use and occupancy'~2,.~,~.,.~ ,~.y .~,~.~..~.... .......................................................................... 3. Nature of work (check which applicable): New Building........:~.. ......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) / 4. Estimated Cost ............... ~'. .......................................... e (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number ,Jr cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions o1: existing structures, if any: Froot ............................ 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 ............. .7.. .................... Rear .......... .~. ............... Depth ....Z'...~. ............... Height Number of Stories .................... .~. ............................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchose ........................................................ Name of Former Owner ........................................................ 1 I. Zone er use district in which premises are situoted ..................................................................................................... 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. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indica}e 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. .................... ~....J~ ................................ being duly sworn, deposes and says that he is the applicant (NSrn~ of indivi?Jual signing contrac'~) above named. Fie is the ..................................... ...~...r ........ : ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, end 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; end that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ / ................. ...~... day of ....... (,~ ~/// x (Signature of applicant)