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Home My WebLink About8422-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AtJTHORIZED) N°. 8422 ".Z ,' Do,e .... : ............... :"'.~ .m~'"~' ....... :', ~..- *:~' Permissi~ is hereby grant~ to: /~.~....~m..~.~ .~...~..~ ............................................................ at p~mims?~at~ at ;'~"~'"A~ ......................................................................................... -~ ~ -~",-'~'-~'---:~-,-,?~ ::~-~~'"~"'-,*~' ~ t ?....r ................................... .~.,:~, ............. ~, ............... ,;~ ....... ;.:.;.Z~ ........... ~.~...,...~,~.;:,,~,~<~,,,,, ....... .,,~ ............................................ ~.., ~nd ~ppr?ved by the FO~.~ ~0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT ............ ..... INSTR. UCTIONS a Th~s application must be completely filled in by typewriter at' in ink and submitted in triplicate to the Buildin., 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 adloming premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this opphcation, the Bu,lding Inspector will issue a Building Permit to the apphcant. Such permi 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 Occupanc' 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 th- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c R.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ...%. (Signature of applicant, or nam'~if a corporation) (Address of applicant) State whether applicant ~s owner,~ agent, architect, engineer, general contractor, electrician, plumber or buitde Nome of owner of premises .... ~ ......... ~ ...... .~...~ ........................................................................ If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No ........ ~ ................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... .C/. Location of land on which pro~osed)~ork wiJ~ be done. Map No. ,... .... Lot No ............. Street and Number ....... State ex~sting use and occupancy of premises and m~.ended use and occupancy of proposed construction' a Exisiting use and occuponcy ......... ~ ........~ .... b Intended use and occupancy ......... ~.(11~.......~ ...... ~ ...... ~~ ............................................... 3 Nature of work (check which applicable) New Budding ...... Addition ................ Alteration ... Repmr .................. Removal ............... Demoht~or ................. Other Work ..... ..~...{~..A4..'.~ ~_ ...................... //~._(~~- (Descr,ption) 4. Estimated Cost ......... ~....~....~..~,. ....................... Fee ........................................................................... (to be prod on filing th~s apphcat~on) 5 If dwelling, number of dwelling un,ts .........................Number of dwelhng 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 ex~st,ng structures, If any' Front .......................... Rear ................................ Depth ................. Height ....................... Number of Stones ......................................................................................................... D~mens~ons of same structure with alterations or addtt~ons Front .................................... Rear ................ Depth ............................... Hmght ................. Number of Stories ............................. 8 D~mens~ons of entire new construction. Front ................................... Rear ............................ Depth ............... Height ..................Number of/Stones ................................................................................ 9. S~ze of lot. Front .......... ~'.~.. ........................... Rear .................................... Depth .............................. 10 Date of Purchase ..................................................... Name of Former Owner ...................................................... I 1 Zone or use district in which premises are situated ...................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation' . ........ Z~ff..(~. ..................................... 13. W~II 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 ....................... iNan-.e of Contractor ................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions frorn propcrty hnes G~ve street and block number or description according to deed, and show street names and in&cate ~vhether interior or corner lot STATE OF NEWff'6R, K/ .~/ ?c .................................................................................'/ ~7/ being duly sworn, deposes and says that he ~s the applicanl (Name of in&wdual signing contracf) above named He ~s the ................................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file this application; that all statements contained thor the work w~ll be performed in the manner set forth in the apphcat~on filed therewith Sworn to befor~e.~ne this .......... ........ . . Nato, Pub~_. ~..G~..~~n~ ...~~ ....... . ........................ ~UOlTH T BOKEN ( ' Nota~ Pubhc, Stole of New No 52-0 ~442o8 Suffolk Couniy ~o~:s,cn Ex,*res March 30,