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Home My WebLink About8050-z FO~ NO. ~ 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) N? 8050 Z Permission is hereby granted to: ........ ~,~llI [~.'~'' S~'~*~' ........................................ .................... ~.o~aAl..&..~ ,.. ~Ba~rte~...~ .... ................................... ~.o.u.Shol~ .......................... to .exe~t..~encJmg...a~..~...a~plic~lon .............................................................................. at premises located at ~0.~..~.....~. ......... J, e4~wa,l~.~...A~B.~4~ ............................................................... ........................................................ Top~i'~'"Da "~'*'~'~'"~yview"~oa~ ....... ~ourbh~ ........... pursuant to application dated ~ ...................... J~l.~ ....... -~. ............. , 19.~.~.., and approved by the Building Inspector. Fee $l..~.gO ............. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT ~~'~ TOWN CLERK'~ OFFICE ~UTHOLD, N. Y. ........ ~is~pproved o/c ....... ~ ~~'"'"~~"" ................ ........ Dote INSTRUCTIONS filled in by typewriter o~ in ink and submitted in triplicate to the Buildin~/~ This be Inspector, with 3 sets of plans, accurate plot plan to ~ole. Fee according t0 schedule. b. Plot plan showing Iocotion of lot and of buildings on premises, relationship areas, and giving o detailed description of layout of property mus~ be drown on ~he diagram which is po~ of this application. The work covered by this application may not be commenced before issuance of Building PermiL 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. ~o building sho~l be occupied or used in whole or in part for any purpose whatever until o Certificate of ~cuponcy~ shall hove been oranted by the Building Inspector. APPLICATION IS ~EREBY MADE to the Building Deportment for the issuance of o Building Permit pursu?t Building Zone Ordino~?e of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regu at ons for the construc~ on of buildings, additions or alterations or for removal or demolition,~os herein described. The applicant agrees to comp y with oll applicable lows, ord nonces, bui ding code, housing code, on~ regular ons, and to admit authorized inspectors on premises and in buildings for n~esso~ ,inspections. ~(Add re*~rs~ f app~lic~nt) State whether applicant is lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. Z/.;."" ...¢..,. Nome of owner of premises .................. **..~*~.. ..~..~*/~t ............ 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 ............................................... 1. Location of land on which proposed work will be done. ,Mep No..: ..~..°..~.,.~.~..~...~. .................. Lot No..;.~. ................... Street and Number .. .~ ........................ ~ ..........................................~ i~"' ........ ;': .......... b/ /~nun c pat ~y 2. State existing use and occupancy of premises and intende, d use and occupancy of proposed construction: b. Intended use ond occuponcy .................. ~ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ....?'..~..YZ...~-(:......'~.....~......I.~...~.IT~x l ! a TM iJ<'Z Descrlptlon) 4. Estimated Cost ............................................................ ,....~........* ........................................................... : ....... (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 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 ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore 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. Name of Owner of premises .................................................... Address ................................ Phone No ....................... 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 ali 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 Iai. STATE OF N E~"~Y,~j~P~,,~ ~¢S .................... ...k¢./~_~....~;.~.~ .................................. being duly sworn, deposes and says that he is the applicant (l~r/f~ of individual signing contract) abow; named. He is the ............................................ ~.~.~..c~.....'~..:7-.~ ................................................................................... / (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 oil statements contained in this application are true to the best of his knowledge and belief; and th. ar the work will be performed,b~he manner set forth in the application filed therewith. Sworn to before me this ..................... .~ day of ....... ~~¢..~ ....... ' 19"7~ Notary Public,. ................ ~/.×7'.x..~l~...,/,~. ...... County ......... · .~ ~1.. zMc~g.? ..4~,/..L. · .,,¢,¢.¢~¢ .....................................