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Home My WebLink About8058-z FOl~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) No. 8058 Z Date ................ , ._y .~ Permission is hereby granted to: :~.z:..Za:,<m.~... ~..~.?:?.~.~ ~. .................................... ..................... ~:~.~.c~.gu.e. ..................................... to...q ~9..q ~....~:~:.~..q ~'-.~...~ .s....~ ~.~...~.l..qe..~ g;.n....~..u. ~. mS .~..tm ~. ................................................................. at premises Jocated at ...~.~FzJ. C,..~8~12fi~. ........................................................................................... ........................................................... .h.~.o..o.~ ~..o. .................................................................................... pursuant to application dated .........................,$~.~..~ ....... ~- .......... , 19...i¢.~.., and approved by the Building Inspector. Fee SJ.:p.~OD. ............ - � r FORM NO. Y f TOWN OF SOUTHOLD Q BUILDING DEPARTMENT i TOWN CLERK'S OFFICE CS►s c SOUTHOLD, N. Y. Examined ....... ........ ...` 19..<� Application No. D.I. . .. Approved. ................................: . .. 192.9. Permit No.c.a.l:........................ < Disapproveda/c ... ........ ................. ... ............ ............ . . ..(Building Inspector). ......................... APPLICATION FOR BUILDING PERMIT , �J Date ................. . .... ....... .... ....... 19...�..' V INSTRUCTIONS M, a. This application must be completely filled in by typewritbr or 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 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 of property must be drawn on the diagram which is part of this application. n c. The work covered by this application may not be commenced before issuance.of Building Permit. 1 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. T 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. t (Signature applicant, name; if a corporation) (Address of applicant) State w hetherapplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . ` .v.�..`Q....................... ................................................................................................................................................ Name of owner of premises . .....�,5 P !"41...1�..,ynC /.�.�.��1.......................................................... If applicant is a corporate, signature of duly authorized officer. . .................. ... .................. ..... .... ....... ............ (Name and title of corporate officer) BuildersLicense No. .................................................... r . Plumber's License No.. ................................................. (� Electrician's License No. ............................................ OtherTrade's License No. ................................... 1. Location of land on which propose work will be•done. Map No.: .............X...... ............ Lot No. ................... .... Street and Number ................. ..e..5_, a/U./.�...... .e 1.. ............. ?^-: ................................. Municipality 2. State existing use and occupancy of premises and: intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... .................... . ...r..............: ....... .I ............................................ b. Intended use and occupancy ........... . ............ ....................................... ... ............�:`..... ........................... 3. Nature of work (check which applicable): New Building. .................. Addition .................. Alteration .................. �n . Repair ------' Removal ------ Den�n|ition---.--- Other Work .. ��./�,x."._................... ,- 8-10 (Description) /i Estimated Cont ............................................................Fee —.----_---_—_----_----__------- (to be paid on filing this application) \ 5. If dwelling, number of dwelling units ---.------Number of dwelling units on each floor ............................ |fgproga number-of cars ' ' . —'-----_-------___— '—.... 6. If business commarciol or rnhuaj occupancy, specify nature and extent of each type of use ....... ---- 7. Dimensions of existing structures, if any: Front ------.—.-- Rear ................................ Depth —. --- Hmioh+ ................ Number of Stories --.--.----.--.----.------_—_--'---_--_----_—.. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth -------- HeiQht .................... Number of Stories --.----_------_------_—.---------------~—. 9. Size of lot: Front --------.---------.- Rear -------------- Oaot6 ................................ l[[ Date of Purchase ----_--.---'_.......................... of Fo[mer Owner —.------_------- .................... ll. Zone or use district in which premises are situated ------.--------_'----.-----.---------- l2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be ............................ Will excess fill be removed from premises: ( ) Yes No lzL Name of Owner of premises .................................................... Address -�.-'--_-..-'_-~,. Phone No. ,...---...—.. Name of Architect --.------------------ Address ................................ No. ...................... Name of Contractor .......................................... ................. Address ................................ Phone No. ...................... PLOT DIAGRAM Lucoia clearly and distinctly all buildings, whether existing or proposed, and indic || set-back dimensions from property lines. Give street and block number or description accordfilg to deed, and 'k et nonnas and indicate whether interior or corner lot. � �7p ` ' � ` . y .�' CJ �~^ ^ STATE OF , . ` ' NE_ // ~� ' -------..z.---- ...........................................................being duly sworn, deposes and aoyu that he is the applicant (Nome of individual signing controcf) above named. Hein the --.-----.--------'-------------'----'----^--------~---~----------- (Controc+or 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 knmv|a6ga and belief; and thor the work will be po,for,no6 in the ,nonne, set forth in the application filed therewith. Sworn me this ..-.—��.��.-' doy nf ..--- �.��... Notary PubU —..'�' .__ ..................... ��TH T. BMEN - r York Nm.��^no�^ruv S.,f""~ county .'-X