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Home My WebLink About8439-z 1~O~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8~39 Z Permission is hereby granted to: ...... - ~ ' ~'o k 1~ ~oe Co He ~Ji~.ltl We ~.~... ...... ~ ....... ~ ................. ~ ....... ~ ......... ,... · ........... ~.~.~.,.~ .............................................. at premises Iocotect at ...~TZ~..]~,.~o:I.~**~.x';L~ .......... .. ................................................................ ..... ~ ....................................... : ........ ~~.... ~,I., ....................... '.,.: ............................................ pH~wnt tb application dated .- ~r ~ ' '.~ , , ..---,0~: . ,.'- . ..................................................... ¢ ]9. ., and oppmy~ by tee Examined .................................rt ...... Approved ........................................ , FORM NO. ! TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ..................................... INSTRUCTIONS o. This application must be completely f,lled in by typewriter o~ in ink and submitted in triplicate to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relahonsh~p to adjoimng premises or public street-~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicati c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such per shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupai 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance- Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descrik The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an~ admit authorized inspectors on premises and in buildings for necessary inspections. ...... ........ (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bulk Name of owner of premises ........ :~...~ ........................................................................................... If applicant is a corporate, s~gnoture of duly authorized officer. (Name and title of c.~ora~_~ Builder's License No ....... ~....iJ~J~..~....c..~-- ....... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work wdl be done, Map No.'~ .......... ;;7 ..... '~ ...... % ...... ~. Lot I~o .... :..~.. ........... Street and Number .... i/.~..~.~..O ...... State existing use and occupancy of premises and intended use and occupancy of proposed construction: o b. Intended use and occupancy ....................................... 3. Nature of work (check which applicable). New Budding ............... Additzon ................. Alteration ............ Repair ................. Removal .................. Demol,t,or .............. Other Work ........... ' '~'~~n')' .......... 4. Estimated Cost ................................... ~..~.~0.~ .... Fee ......... ; ............ .~-.~-'.~.4~.(~ ......................................... (to be pdld on filing th~s apphcation) 5, If dwelling, number of dwelling units ........................ Number of dwelling units 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~mensions of existing structures, if any' Front ....................... Rear ................................ Depth .................... Height ........................ Number af Star,es ........................................................................................................ D~mensions of same structure with alterabons or additions Front .................................... Rear .................... Depth ................................ Height ........................ Number of Stones .............................. 8 Dimensions of entire new construction' Front .................................. Rear ........................... Depth .................... Height ................... Number of Stories ....................................... 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 law, ordinance or regulahan: ..................................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. 1'4ama of Owner of premises ,~..~¢ro~...,~.~ ............... Address .1~.~.~:.~..~... ,.~,~., Phone No. ~.~.t2,._...c~~, Name of Architec~ ..................... ~ ............................... Address .........(.. ......... ~ .......... Phone No ...... ~'. ............ Name of Contractor ...................................................... Address ................................ Phone No .................... PLOT DIAGRAM Locate clearly and disbnctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions fro property hnes Give street and block number or descr~phon according to deed, and show street names and mdica whether interior or corner lot STAT~- OF NE [ S S "~~ ,*L/~ .rjr-.4 .... - COUNTY O~.~..?..: .......... f ' ' ' '- ................ ..~.~..~..~........~:...~.e.~.~.G.ql~.~~ '~' -- ............................ being duly sworn, deposes and soys that he ,s the apph (Name of individual signing contract) above named He ~s the ......................................... g~.~q~ ............................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make this application; that all statements contained in thts apphcohon are true to the best of h~s knowledge and behef. that the work will be performed m the manner set fo~h m the apphcation filed therewith. Sworn to before me th~s ......... ~ ..... day of ....~ ................... , 19~6. ~ ~ ~~~. Nota~ Pubhc, . ...................... ~¢~O~ ........... Coun~ . .~ ........................... ~ (Signature of applicant) , NOTARY ~tc o~ 4,~ ym~