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Home My WebLink About8034-zTOWN OF $OUTHOLD BUILDING DEPART~ME)qT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8034 Z Permission is hereby granted to: Twi~.?..~.ei~k...F*c,~e,.*~c.....:r~/¢,..r~!.ga. te...C.on~rete produet~ Inc ......... · M~.~.~,& ~.,~ek. ................................................ to ...t, ~../a ~.~ a.~*. :~e ~,~,.* .a~*~.. · · ~.~.de.* ~.~ *~.. -~e ~c-i~.g*. ~... (~1:'~- "h-i-gh't ........................................ ........... .N ¢~.~ ...F.~_ en~...ya~cl...he.~.g.th...sut~ e c~.. ~b o...vg~t~u~.. T~...Bd.--~p ~al.~ ...... ot premises located at ........................................................................ 8eu.gho~d'"'*'t',~ ~ ~ ....................................................... pursuant to application doted ........................~J'YL~f~'"~* .............. , 19..~/~, and approved by the Building Inspector. Fee $4.9,~.~(~ ........... .......................... ......................... ~O~l~Z ~O, 1 TOWN OF SOUTHOLD BU~LDIHG DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined '"~*/*'*'"'"!! .......... .c.,~.***~**..., ii**~.*ii~.*?Permit No... ,~***~.**.~.*.~ ...... Approved ~ ~ (Building Insp~tor) '~~ APPLICATION FOR BUILDING PERMIT Application No.....~....O..~..~. ........... ~ INSTRUCTIONS '~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Bu~ldmg-~ 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 or,~*~ 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 Buitding Permit to the applicant. Such permlt ~ shatl 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 applicant) State whether applicant is owner~esse~, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...?...~..~...[..~%~..~.....~-.:.......~.. ........... .¢/.~.C~{/rx~...'---~.~..~.....~..~.~-.¥-.v...~..~. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~..~,.~(..d[.~...~.....-~..?....(..'~ ....... Plumber's License No.* ................................................ Electrician's License No ............................................. Other Zrade's License No ............................................... V Location of land on which prop. osed work will be done Mop No * ../...~m.. . ~ Lot'No .. , Municipality State existing use and occupancy of p[emis_es and intended use and occupancy of proposed construction: b. Intended use ond eccuponcy ..... .~.~/.~--:... .......................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ..... · .q~..?...../~....Ct../.. · ,'~....f~. .............. ,._ (DescrilCtion) 4. £stimated Cost ............................................................ lee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwellin§ units ............................ Numbcr of dwelIin§ units on each floor ............................ If 0aroge, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each typo 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 ............................ Depth ................................Height ............................ Number 8. Dimensions of entire new construction: Front ..... .............. Height .................... Number of StorLes~ .................................................................................................................... 9. S,ze of lot: Front xJ..~..~. ............................................. Rear ..........~,..u.z.r:.. .................. Depth ..... ,...a .......... : ........... 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 [aw, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No ,.14. N~rne~f~wner~fpr~mises~..~...~.~./~.~...~..--~...~.~.~..~...~..~...~..~...r..~.~..... ,~ddress Name of Architect .............................................................. Address ................................ Phone No ............. .......... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y]DRI~I- ~~' t,-~.~,- ~ . ~ . ' ,~NTY 0~~ ......... 7..L~ ...........~..~.~ ....... ~~., ............ being duly sworn, deposes ~nd says that he is the ~pplic~m (~me o~ individual signing contract) ~bow~ n~med. He is the ................................................................................................................................................................................. (Co~tractor, , , . of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fife this application; that ali statements contained in this application are true to the best of hfs knowledge and belief; and thor the work wi]l be performed in the manner set fo~h in the appiication filed therewith. Swor.~ before me this ~ /~ ~~ , ~......~.. day of ..~~ ................ , 19~ ............ .............