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Home My WebLink About8698-z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8698 Z Date ......................... J'.~X~ .......... ~ ......... , 19.~76.. Permission is hereby granted to: ........... ~a/Lia..£{oad ......... ~ia.tt i. tu~ .......... to ~.~:~..q~....'.°.f.L.~'.~.~ .$. ~.r~. ~...~..~.t fL - .~ ......... z.:-:.. :3.r,~z'...a:~..¥3.ic~,.~.&~ ........................................... at premises located at .~.~L.,...i2.~z.t..3,o~....~y..~.x.~%i4,;~c~4....)f~:~,~.~>f~ ....................................... ....................................... A~lla..~¢~.cl ............ ~a.t;t,i.tu~k.....~¢.~.. ............................................... pursuant to application dated .................... .~.]-.~5~......~ ................... 19..~.~.., and approved by the Building Inspector. { [~ ~'- BuiFding Inspector / FORM NO. I TOWN OF sOuTHOLD BUILDING DEPARTMENT Disapproved a/c ....... .~m...: .C:~. 2.2'..~. ................... "'i' ' 'i ' inghnspector) .......... APPLICATION FOR BUILDING PERMIT ate ............. .~./...-....(. ................ , INSTRUCTIONS a. This application must be completely filled in by typewriter off 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 os 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 app!ication 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 i~suance 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 alte[atiens, or f0~r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hoosing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in~ections. (Signatur~ of applicaht, or ~ame, if a corporation) ........ (Address or applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.~.~..~.'~ ~ ~ applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No .......... ~~... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will b,,e done. Mop No.: .....z/t..,.~.,....~,.. .................... , Lot No~ ...~....~':.?..~.... ........ Street and Number ..... .~.,r.~..~..~...~...~,... ............................................................................ .............. Municipality State existing use and occupancy of pren~s an~]~l~tended use and occupancy Of proposed construction: b. Intended use and occupancy ................................ ~~ .................................................. 3. Nature of work (check which applicable): New Buifding~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .~....~ .................. (Description) (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, 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 construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ....................................................................................... ~t.~:L~"m~z"~'~':"?C~ 9. Size of lot: Front .... .¢..~ ........................................... Rear...~..C..~..:..~...'~/. ..................... [~ep, th ~.~,~..~.....~-~ 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 law, ordinance or regulat[on: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises:,( ) Yes ( ) No 14. Name of Owner of premises ~J..~.~ ..... Address .~...~..~...~.... Phono No..~...~....?..~....~...('% Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor,,. ........................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all 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 Iot~ STATE OF NEW YORK, COUNTY OF .... -q11~-~O'] k .......... ............................. ~..~...}~[~.~ .............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ....................... ~ ......................... O~¢. ................................................................................................................... (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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this .......... ~,11 ~1. ...... day of ..................... Notary Public, . ............................ ~U~' .~"~.q,k. ..... County ...................... ~.~.,- ...................................................... (Sign6~Gre of applicant) ' ~ ELIZAB£TH ANN N£¥1LLE NOTARy PUi]£~C, State of New York