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Home My WebLink About8046-z FORI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8046 Z Permission is hereby granted to: ~ona&.d...~.%.lak~o~ ......................................... ................. O¢.i.e.n~ ................................................ to ...~Z'~.C .~... £~ana.illg.... ~c..p o~t~..&., s hz%xb e ~'.~... as...pe~.., apt~l i~a ~zLon ............................ at premises located at ....~.r~A~a.te...i{og~(~..o~.f..~./.$...~4~iz~..l%oa~ ............................................... ............................................................ O~'.le;~t.....~.~.. ........................................................................ pursuant to application dated ........................~l'.~r.....~ ............... , 19~.~.., and approved by the Building Inspector. Fee $.t ~.,~00. ........... ............. ...... ................. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~?../.~. SOUTHOLD, H. Y. Examined ...... & 19.?.~.7 proved .t.Z.. ....... !.!./ ...... .X ...... , No. APPLICATION FOR BUILDING PEKMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot p an showing location of at 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 th s app cat on. 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. e. No building shall be occupied or used in whole or in part far 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 Buildln Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~ulotgions for the construct on of bu Idings, additions or alterations, or Tar removal or demolition, as herein described.x~ Th~ applica'nt agrees to comply with all applicable aws, ordinances, bu Iding code, housing code, and regulahons, and to admit authorized inspectors on premises and in buildings for necessary inspections._ ~ [Iz' ,' rj .............. .., · (.t,.:..:..?.'..Z~ .................. (Signature of applicant~ or nam~ if a corporation) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~..~.~~ ......................................... L .................................................... If applicant is a corporate, signature of duly authorized officer. Builder's License No ...... ~....~ ...................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ t. Locat on of land on whifh proposed woTk will be d~ne. M~p No.: ..;~..- ....... /......;.~vz.: ........ .../.. Lot No...z.~. ................. Street and Num 2. State existing use and occupancy of~l?~mises and_:~ntended use and occupancy of proposed construction. a. Exisiting use and occupancy ...~~..//~/'~ ................. .,~ .............. ._* .................. ::,,,.*...z ........ b. Intended use and occupancy ................. (.! ......... ~__~~...c..~y.~ .~...~..~~....~... 3. Nature of work (check which applicable): New Building~· ................. Addition '"'ztL~.~, r,,- ~ ,,_,,~- ~. -~ ..Alztelati°n ............... Repair .................. Removal .................. Demolition .................... Other Work .:!..[.'.QI.!~..U.'....k.,()../.~!~.'/.!.~..~.{!..!.(? ~ ,. #.,_-- ~..~ 0'o ' (Description) 4. Estimated Cost ::Ul[..[~ ................................................... 0 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 occupancy, specify nature end 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 ..................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................Name of Former Owner ........................................................ Zone or use district in which premises ore situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded . ......................... /. Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premise~`~L'%h~:L.~?~t~j.~(2:h~.[!~.~'~c.*~Address~'(;~..?~?.~).~.~:~tJ Phone No. ~.!:..z...C.~L!...(f;. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate 10. 12. I STATE OF NE'v~ YO[I~., ~ ~ [ c c COUNTY OF ,~-~ ......... ~'""~ .............................................. ~.'2¢~...~..~'...~~...being duly sworn, deposes and says that he is the applicam (Nome of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 thor the work will be performed in the manner set forth in the application filed therewith. / Sworn to before me this day of ...... ........................ , ............. '' Notary Public ........ ~X.~.~/' .~er~.......~m~... ............... ~.oun~,/ ...,..w. .......... : ...........~ ............................................................. .- . I ~ (~ gnature of applicant) MIRIAM HARTLE~ Ii'OTAR¥ PUBEIC, gt~te of No. 52-1695,~o0 ~affolk Cot~ ~ssio~a Expires ~Iareh