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Home My WebLink About8022-z FOR1Y[ 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 COMPLETION OF THE WORK AUTHORIZED) Ne 8022 Z Permission is hereby granted to: · I,;ew.~h...Fex, k...~a.p.~.~ ~¢...~. ht~vch .................. ........... Mi~d-~e.-.Road. .......................................... ............................ ~4a.~-.~& ~ek ........ t6¥~-, .............. to .~.~g.~...~.~.~..~.c.~.~.~g..~e.~...(2~..s.~r~.ur.¢:s...~p.~..~.~k.p.~.e~ a~ag..~...~.~p.~l~..~l for. addition ~n Ch~ch b.u~d~ on m p~em~ses hoofed c$ ~/~..~.~ltd. l.e..~oa.d.....(C 2~.~ .................................................................... .......................................................... ~a.$.t It~ck ...... ~{..2, ........ , ....................................................... pursuun~ ~o opp~coHoo doted ........................... J~e'""~% .......... ]9.~.~.., Build,n9 ~nspecto~. Fee$.~ ............. , ,v -- Building In'~e~tor ( (l'ea~ ~ ~ ,~'-~ BUILDINGTowN CLERK'sDEPARTMENToFFICE Sou'rHOLD, N. Y. Disapproved a/c .................................................................... ildi APPLICATION FOR BUILDING 'PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the BuildingL 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 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 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. L) 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... (Signature of applicant, or name, if a corporation} ............ (,Address of applicanti ....~'-' ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ .................................................................................................................................................................. Name of owner of premises .....~....O.~.~...~.?.~.....~..~.~-/~.~......(~.~...~:..~ ...................................................................... t~authorized officer. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done~ MaD ,No.:.~....., ........ .~. ............. ~..;~..... Lot I~1o ..... ..~ ................ Street and Number ....... .l~...~.......~....~.~.. ................ ...~x'~./~....~/~l~ ..................................... ~.~..~.'.~.~./~ ..... Municipality State existing use and occupancy of premises and intended use aFd occu~a, ncy of proposed construction: a. Exisiting use and occupancy .......... ~..~.~S.~!:~. ...... :~ ...... ~..~../.'..S....~.:~...~......~...~[~...~.~..~. .......................... b. Intended use and occupancy ....... .~.. ....... le~$..~.~ ................. ® 6l/~1 ~.~....~:'~.1~ ........ ~..~.t/.e~. ............................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ............ ~..~ ........................................... Fee .............. ~.. ....................................................................... (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 o~Cupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .............. ..~.....~. ....... Rear .................... ............ Depth .....~...~.. ........ Height ...... .~.~-. ......... Number of Sto~ies ~'~ · 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 ............./.. 9. Size of lot: Front ....................................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................. i'i ..................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~. ............... ~ .............. -.~ ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. .~. ................................ 13. Will lot be regraded ...... ~"~'~ll a[~- --d.Will excepts .fill_ b.e removed from premises: ( ) Yes ( l~No 14. Name of Owner of premises .J~.~.~...I.'l...~...~.......{~...~..-~'.l~..l~'.;,.~.l/.j~/jl~ddress ................................ Phorte No ....... ? ............... 'Name of Architect .~.,..{1~.~'~ ~1111.~.......~...~.......~.~... ....... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description occ?~ding to deed, end show street names and indicate whether interior or corner lot. ~1~0 .t. STATE OF NEW YORK. - ' ISS COUNTY OF ............ ~',~..' '____ ~ '~---"~t~ll~'"~'"'~:~'~"~' ........... :~. ................. 'b~mg~ses ~d says t~t he is the opplicom (Name of individual signing contract) above nom~. the ....................... ....... ' ............................' .................................................................................................... . (Contractor, agent, co,rate officer, etc.) of ~id owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are t~e to the best of his knowledge and belief; and thaz the work will be performed in the manner set fo~h in the application fil~ therewith. ~ '~'"'~'~--~'"--¢~__ J. '.-- "Z~~ ~ (S,;;;;;';~applicant) .................... N~ARY PU~.IG, S~te ~ New Y~