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Home My WebLink About8040-z FOI~M ~NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OFFIG£ SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N.o 8040 Z Permission is hereby granted to: ~o ..... 6. E?.~..C..'.Z ........... ~ ............ ~.~....c...~..~ ................................................................................ at premises located at ......... '?-..'.?. ....... ,,,~.../../:...~.~.. ...... ..~-~.~-/~..~-..~...'-~..~(. ...... .,~.,/.,~...-~.~. ....................................... pursuant to application doted OOJ. '/ [ 1~...~..., and approved by 'the Building Inspector. Fee $ ........................ Building Inspector FOB,~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /.~ SOUTHOLD, N. Y. Examined ....... ........... ........... ~· ~ Permit No ~'~C~ ;7.'. D~sopproved a/~:~ ........ ~'"',','Z' .......................................................... .......................................................... (Building fnspectorJ APPLICATION FOR BUILDIN~ PERMIT Date ................ ./. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 o~ 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 o Building Permit to the applicant. Such permit 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 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, end regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............ .................. (Address of applicant) State whether op~wner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. ................... ...................................................................................................................................................... Name of owner of premises ................. ..~.....~.....F..'.~......~-.....~... ............. ...~:...~...../.....~...L..../..-~... ......................................................... if applicant is a corporate, signature of duly authorized officer. ....~-~--..~.,.~?.~.~.<...~ ....... ~Lu.:~...s..~.~.~. ....... ~.~z ............ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....................... ~ ..................... Electrician's License No ..................................... Other Zrade's License No ................... ; ........................... 1. o o ...... ~¥..~.'. ............... .at No....~.. Location of land on which proposed work will be done. M p N .: , .~.Z~.. ................ ;:re.e a.n.d Numbe_rb~.otetexls,ing useand occup ,prem ntend pa os o. Exisiting use and occupancy .....................,'n.:.;.; ................. /.,-,., ............................................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ....... .~'....~.-...~..'..~..: ..L.-. ,,, ................ ' (Description) Goo ............................................................ 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 accupancy, specify nature and extent of each type 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 of Stories ................................ 8. Dimensions of entire new construction: Front .................... · ............... Rear ............................ Depth ........................ Height .................... Number of Stories ....................................................................................... ~.._ ........................... 9. Size of lot: Front ................../..?....0. .............................. Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner .......... .J. ............................................ 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 ............................ Will excess fill be removed from premises: ( 14. Name of Owner of premises ........ .-=.,.,..;.....=.= ................. Address ....:~.¥..~.%.~ ....... Phone No Name of Architect .............................................................. Address ................................ --v~"7 Phone No ....................... Nome of Contractor ...... ..~.....l~......J~q.!~..J .......... ~..~...~...¥...~?..Z..Address~/~ ............................ ~....~.UZHO~.~... Phone"'l~'-No ....................... ~ 0 0 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 YORK, [¢c COUNTY OF ................................ _ ~ 7_. ~.~ ~-~ 0 T ~ ~ bein deposes and says that he is the applicam ....................... ~ .............. z ..................................................... g duly sworn, (Name of individual signing contract) above named. He is the ............................. ~.~.~.~.~.~. .............................................................................................................. (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set foah in the application filed therewith. before me this ......