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Home My WebLink About8715-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 8715 Z Permission iS hereby granted tO: Orient to ....~J~L..aa..a.~di~;J,qzk.om..exia~..dwallin~ ............................................................. at premises Iocatec at ..... ~T. Qz%l~k..~.~.eW..~.I.~.~ ............ ]~J~o.~z~s..~i~ 1 s ..................................... ...................................................................... ~ie~t ................................. .. .......................................... pursuant to application dated ................................ ~tt~r ....... ~ .....19....~16, and approved by the Building Inspector. Fee $..~J. ~.,.QQ. .......... FORM ~0. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT , TOWN CLERK'S oFFICE SOUTHOLD, No Y. Examined. .................. / .... ....., ...... ...., Application Not ~ 3r ApprovecJ~./.~ .............. /. ....... :~..: .......... , 19...~... Permit No. ,, ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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, relatiohship to adjoining premises or public streets oF areas, and giving a detailed description of layout ofproperty must be drawn oh 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 Jn 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 laws, ordinances, buildibg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa,ry inspections... (Signature of applicant, or name,/~if a ~:orpf~ration) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ....... ............... ............. ............. ............... ..................................................... ............ f V ...... ' Name of owner of premises ............................................................................................. ....................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of ,c~orate ?ficer)~ Builder's License No ............/.~,~ ............ ~ ?.,.., .............. Plumber's License No .......... ~.~ ............... ; ......... ~ ......... [lectricMn's kicenso ~o ............................................. Other Trade's License No ...... ~. ........... ~ ....... p ................. (+~ ' 1. Location of and on which'~opos~d'~br~w( be done. U~ Nm:-, ~.'.= ........ ~ ....... ; ......... ~;,~.. Lot No ......................... 5treat and Number ................................................................................................................................................... Municipali~ 2. State existing use and ~cup~ncy of premises and in~ended use and ~cu~ncy of pcoposed construction: - // . / /; o. Exisiting use and occupancy ................................ [~..~7~....~: ................ ~ ~ ........................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition ...~ ....... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... '"~-~ "0' ~ ,.~"'- ~) 0 (Description) 4. Estimated Cost .............. ~'........~........: ........................... Fee ..... L ........ ii~i~.. .................................................................... (to be paid on filing this application) 5, If dwelling, number of dwelling units .......... ~ ...... Number of dwelling units on each floor ............................ If garage, number al~ 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 ............................ De th ...... Height ............. Number of Star es p ........................................ / / ,~. 8. Dimensions of entire new construction: Front ........ /~ ..................... Rear ...~...~.. ................... Depth ...... ./.....~.. .......... Height ..~..../.~..../..x,. Number of Stories ..4~...~.....~.. ....................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 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 regroded ............................ Will excess fill be removed from premises: ( ) Yes (/~) No 14. Name of Owner of premises ~.l_/.~.-C,¢,¢,~........,~....~....'~....~...~..¢'~'~Address-- -- ................................ Phone No ....................... Name of Architect ~.~..~.....~.J...~.~.~.,Z.;...~....~.~''~/- ' .................. Address .~....1-c~..~.~....~...~..~,' Phone No ....................... Add r ess ~..~..~..~....c~.'~/.~,".....4~l~one Name of ......................... N ~..,,~..~.....~...?... ,,~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propeFty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. COUNTY OF (~/1'~.....' ............................... :,......: ..................................................... being sworn, (N~~Zi~,.,,~,,,,, signing contract) duly deposes and soys that he is the applicam abow~ named. ~ He is the .................................... ~ (Contmctor~ ............................................................... 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 perform~ the manner set fo~h in the application filed therewith. Sworn to before me this I ................... &0o o, ...... Pubhc, . ........... ;~ .... Coun~ ................................................................................................. ~ , //~ .~(..~~~( (Signature of applicant) No. 52.8125850. Suffolk County term Expires March 30.