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Home My WebLink About8433-z FOR!~ NO. 2 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWH GLERK'S OFFIGE $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8433 Z Permission is hereby granted to: ~.~.,~ ...................................... :: ........... .............. :. ..... ~..tI~11~.. ra .......... at premises located at ....~...Ii~A/~.,~Q~.,~,., ~.'.~.~i~ I~,~-- -- ............................................................................ ...... ~ ............................. :,..,:.,::....~.?,;~~....:.~....;:::..:.:. ,:~,~ ......:....:..., ..... pu~ua~t ~ app ication date~ .......................... ~..,..~ ........ , ,1~..~, and approv~ by the Bui[~ing 'lnsp~tor. - " ,{ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a~....;~ ............................... ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled Jn by typewnter or. 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 Iocatior} of lot and of buildings on premises, relationship to adloining premises or public streets o areas, and g~ving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s application c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Budding Permit to the applicant. 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 Occupant,. shah 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 o Regulations, 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 name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises .... .~.f~.~lt...~.~. ................................................................................................................. If applicant is 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 ............................................... Location of land on which proposed work will be done Mop No ' . ...... ,~ ....................... Lot No..;1~ ............... Street and Number ..~r/.~...C4Ox..]~eD~..~o&c~ .............. ~a.t¢~.t~k. ............................................................... Municipality State existing use and occupancy of premises and in'.ended use and occupancy of proposed construction: a Exisiting use and occupancy ....~/.~t~k~ .................................................................................................. b. Intended use and occupancy ............................ l~-~.~LCl.~t:~bO~ ................................................................ 3. Nature of work (check which applicable) New Building ................. Addition ...-:~i~ ....... Alteration ....... Repair ............... Removal .................Demoht~or. .......... Other Work ............................................... (Description) 4. Estimated Cost .......................................................... Fee ..... ]~.A.(~ ................................................................... (to be paid on filing th~s application) 5. If dwelhng, number of dwelling un,ts ...... Ol:~r ............ Number of dwelhng umts on each floor ........................ If garage, number of cars .................................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mens~ons of existing structures, if any: Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stories .................................................... ; .................................................... D~mens~ons of same structure with alterations or additions Front ................................... Rear ........................ Depth ................................ Height ........................... Number of Stories ................................ 8 D~mensions of entire new construction. Front .......... 1.~. .................... Rear ......... t,~. ............ Depth .....1.6 ..... Height .................. Number of Stories ..... O~e ............................................ 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 ....... rt~tt..~l.l~t~ ........................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ........ XO .......................................... 13. Will lot be regraded ............ ~.0 .......... Will excess fill be removed from premises' ( ) Yes ( ) No 14. Name of Owner of premises ........ ~'ecl...lge.'~..L~ .................... Address ...... ~a.t,~;,1..l:,~,~... Phone No. ..................... Name of Architect ........................................ Address ................................ Phone No ...................... Name of Contractor ................ O~Z~:~ ...................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and indicate all set-back d~mens~ons fror property hnes Give street and block number or description accordtng to deed, and show street names and indicat whether interior or corner lot I ' STATE OF NEW YORK, S.S COUNTY OF ....... St~'~'~]~ ....... I' ........................... ~:l...lgG~l~, ............................................ being duly sworn, deposes and says that he ~s the apphca~ (Name of ind~wdual signing contract) above named. He ~s the ................................... ¢i~t~e~..b.~J..TL~.~ ..................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f~ this application; that all statements contained in th~s opplicc~tion are true to the best of his knowledge and belief; at thor the work will be performed m the manner set forth in the apphcat~on filed therewith. Sworn to before me this ................ D2.. day of ................... }k~.¢h , 19 ~ .-1~'" ,9 ,// ..... Notary Public,. .................. S~f'.:~O.'LI~ ............... County ..'~ ........... ~... (Signature of applicant)