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Home My WebLink About8352-z ~O~l~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTN~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMI~I' MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ,8352 Permission is hereby granted to:, FO~ NO. I Examined .... ~L.~..,._........~C~. ........ , Approved .............................. /. ........ , TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~U.2. Application No. ('- ' ~' Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING FERMIT Date ,.Tanua~?y 9 19 76 INSTP, UCTION$ a. This application must be completely f, lled in by typewnter 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 prem,ses or public streets o~ areas, and giving a detaded 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 wdl ~ssue a Budding 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 alterat,ons, 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 necessary inspections. ' ($ignc~ure.~pplicant, or name, if a corporation) -.-~D-.D L; --~;iekham ave [,iatt. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ..J.~...~..b..~:..~.~...}.~..,....~...o.g.~.k...~.,~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Budder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ?/x ~ I Location of land on which proposed work will be done Map No .................................. Lot No ........................ Street and Number .... l;,~..c..~.~.a..~.....k...v...e. .......... !~.~,.~.~,~.~.Ck- .................................................................................... Municipality 2. State exmting use and occupancy of premmes and intended use and occupancy of proposed construction: a Exisiting use and occupancy ...D~...e...~..~..~,~, .......................................................................................................... b Intended use and occupancy .......... ~e-",'~'~'~;~' :~Z~t~ ........................................................................... 3. Nature of work (check which applicable). New Building .............. Addition ................ Alteration ........... Repmr ................. Removal .................. Demoht~or. ............... Other Work .... ~.e~..~J,t~ ........................... (Description) 4 Estimated Cost ......................................................... Fee ...~ ~.,D~0 ................................................................... (to be pa~d on flhng th~s application) 5 If dwelling, number of dwelling un,ts ............ ~8. . .Number of dwelhng units on each floor ..................... If garage, number of cars .............................................................................................................................. 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each b. pe of use .......................... 7 Dimensions of ex~stmg structures, if any: Front ...................... Rear ................................Depth .............. Height ........................ Number of Stones .................................................................................................... D~mensions of same structure with alterations or addmons' Front ................................... Rear ..................... Depth ............................. Height ....................... Number of Storms .............................. 8. D~mensions of entire new construction Front ................................ Rear ............................ Depth ................. Height ................... Number of Storms ........................................................................................................ 9 S~ze of lot Front .................................................... Rear ..................................... Depth ............................... 10. Date of Purchase ..................................................... Name of Former Owner ...................................................... 11. Zone or use district m which premises are s~tuated .. ,~*t...~. ............................................................... 12 Does proposed construction violate any zomng law, oral,nonce or regulation: ..:~ ................................................ 13 Will lot be regreded ...... ~ ............. W,II excess fill be removed from premises: ( ) Yes ( ) No 14 Name of ~ner of premises "~Obe~' 9oe~ .......... Address ........ ~ .............. Phone No ....................... Name of Architect ............................................ Address ................................Phone No ....................... Name of Contractor ..... ~e~ .............................. Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and d~stmctly all bu,ldmgs, whether ex~sting or proposed, and md~cate all set-~ck dimensions from prope~y hnes. Gwe street and block number or description according to deed, and show street names and ,nd~cate whether mnterior or corner lot __~~ STATE OF NEW YORK, [S.S COUNTY OF ...... .j~.~ f~.~.. ........ (Na~i':~'in'~!i~'~g,,,~r ~, ,~,,,,, contractO being duly sworn, deposes and says that he ,s the applicam above named He is the .................... f.m'~ez'"~'"b~r~z~.~--: ............. : ............. :'" ;'; .......... :"¥ ...................................................... t~onrracror, agenT, corporate officer, ere ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the said work and to make and file this opphcation; that all statements contained in this apphcot~on are true to the best of his knowledge and behef, and thor the work will be performed in the manner set forth m the apphcation fried therewith. Sworn to before me th~s .... ............ .... , .................. day of...}; ....... Notary Public, . .......................... ~._~}.j~ ....... County ~ ~ ' ". " ~'-~. "~:~'~¢,¢~z .............. I'[0TARY PJJBLJC, St.,~c rf ~:l'', Ten~ Expffes M~'ch S J,