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Home My WebLink About8572-zTOWN OF ~4UTHOI.9 BUIL~INQ DEPARTMENT TOWN CLERK'~ ~ SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8572 Z Date ........................ Permission is hereby granted to: ............ ............................... ....... ~/o~.~v~k ................................................... to ~u.ll~...n~w..a c.~e~s cu:~...s.ta~ g~..huil~i~ .......... ~ Coa~l~..~;.t, op~e.). ......................... at premises lacated at ..~/.,a..,aa,$~..~a~, .......................................................................................... ........................................ ,Ke..t,:~..t,~,~e k..... ~ .. ~., ................................................................................... pursuant to application dated ........................ :,~&]~ ......... $~ .......... 19.~.~.., and opproved by the Building Inspector.. Fee $..1.~e~ ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................................... . .......................................... APPLICATION FOR BUILD/lNG FERMIT INSTRUCTIONS Application No ................................. a. This application must be completely filled in by typewriter 0¢ 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 d~grom 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 o 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 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises' and in buildings for necessag/4pspection,s,.* j, ~not~re of applicant, or nome, 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 .................~::..f..l, ............................. ,.: .............................................. If applicant is a corporate, signature of duty authorized officer, (,Name and title of corporate officer) Builders License No...D;...L~..'~.~-.C,d. LL~.. ................ Plumber's License No ................................................. Electrician's License No ............................................. Location of land on which proposed work will be done. Map No.: .................................. Lot No ..................... ~...~ ~? ~ /l~f~ ii ~,.~_(.¢,. t>c',-~,~,.) dLL~<£c~ ~-~ z ......................... Street and Number ...~ ...................................................................................................... ~ ............ Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~..'.~.~.~.~..~J.~-. ..................................................................................................... b. Intended use and occupancy ........ ~.....~ ................................................................................................................. 3 Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration .............. Repair .................. Removal ....... ~ ...... Demolitior, .................... Other Work ................................................... 4, Estimated Cost ~' '7-~ ........... Fee /.'.~./'~ .d~:)~ (Description) (to be paid on fiing t is appica ion) 5. If dwelling, nurnber of dwelling units ............................ Number of dwelling units on each floor .... If garage, number of cars ............................................................................................................................................ 6. If business commercial or mixed occupancy, specify na~ture and extent of each type of use ....... ~ ................ 7. Dimensions of ~xisting structures, if any: Front ......... .2-...,.°t-, ........... Rear .......... .,~.. .................. Depth ...... I...! .......... Height ...... L..'~.. ............ Number of Stories ......... I. ....................................................................................................... Dirnensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth -- Height ............................ Number of Stories ........ : ....................... 8~ Dimensions of entire new construction: Front ....... .%7..; ........................ Rear ........%z ................. Depth ........................ Height ...... ~ ......... Number of Stories .................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10, Dote of Purchase ........................................................1'4 e 11. Zone or use district in which premises are situated ........ .~...~...~J.?.'.¢.~.~..,~. .................................................................. 12 Does proposed construction violate any zoning law, ordinance or rebulation: ........ .I.,:?..'.O. ......................................... 13. Will lot be regraded .........r~....'.O.. ............Will excess fill be removed from premises: ( ) Yes ( '-)-'No t4. Name of Owner of premises ....... Phone No. ~.~.~..:-..~-.!.~.O Name of Architect .............................................................. Address ................................Phone No ....................... h!ome of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and shew street names and indicate M~ether interior or corner tot. 1 : I,~,, L OF' NEW '~ ORIx, I c c cOL, ~ ~ , OF ..... Suffolk .......... ..................... R.o~...~ohQ.~h~r. ......................................... being duly sworn, deposes and soys that he Js the applicon~ (Name of individual signing contract) abow~ named. Fie is the ........................................... D'v~ez'. ........................................................................................................................ (Contractor, agent, corporate officer, etc.) al~ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl~is application; that all statements contained in this application are true to [he best of his knowledge and belief; and lha~ the work wilt be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ..... of .................... ........ " Notary Public, . ...........................SLL~.fOJ,~ ...... County ... ,~..f:..:..~.~ ........ ;;: ................ ;. ....... ; ...... : ............................. , / ~ignature or applicant)