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HomeMy WebLinkAbout8061-z FOI~NI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8061 Z Permission is hereby gronted to: .................... ~t.o..e.~....~.o..~,~..~...~..o.~ ..................... .................................. .~ ~.~..% ..~.z.:.t...o.~ ................... to ...L:.~.e..q %...~... ~e..~.¢~ ~. a .. ~.~.o..~.¢._ .~. ~.[~... ~ .e. ac..$.~ ..~.~...~..e.~...~. !S.c. ~..¢.!9.~. ................. at premises located at ....~..o.,~7...?...o.~.~.,..?...o.a.~. .................................................................................. ~a~t Marion pursuant to application dated .........................~.~.~.~.....~ .............. , 19....~.~., and approved 'by the Building Inspector. Disapproved a/c .................. APPLIGATIOH FOR BUILDING ,ERMIT~. ~t ~...: ' Date~..l ............... ~. ............ ,19. INSTRUCTIONS a. This application must be completely filled in by t~Aoewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 ocljoining premises or public streets or areas, and giving a detailed description of layout ofpraperty 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 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 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 pursu.?nt to the.~f 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 regulatJofls, and to~. admit authorized inspectors on premises and in buildings for necessary Impections. ~ ...... ......................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~'P,/~(~.~..,:.~.~...,~...~,.,~../~....T....~..:.~..~~...~....~.~Z~.~~ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ×,- Budders L~ce~se No ....................... Plumber's License No ......... ~ .................. ; ......... Electrician's L.icense No~ .............................. Other Trade · License No ............................................... Location of land on w_hich praposed work will be done. Map__No.: ............ ~.~; .............. Lot N~o~ ........................ Street and Number~...~.~'/.,~...~. ........ .~..~..~...~/..~...: ........................................... Municipality State existing use and occupancy of pre, es and,,i~ntended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~'~'"':'"'"-~~/L~/~ ' ~*~'~t /.//~/ ....................................................... b. Intended use and occupancy .......................... ~. ................ ~~"~::'['~7' ........... ~ ....................... .... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Wa rk~..t~.....~...&~..{~.. ~; .......... ' ~0'O (Description) 4. Estimated Cost ...~.~......~-~........"'.:;."-- ~ ' ............. Fee .../..~...~....//-~ ................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling Units on each flo. gr ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, spe~cifY 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 ...L~.~. ....................................... : .... Rear .....J'..~...~.. ........................... Depth ....~ ................. 10. Date of Purchase ........................................................ Nome of Former Owner ...... : ................................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. W'Jll lot be regraded ............................ Will excess fill be removed from premises:.( ) Yes ( ) No 14. Name of Owner of premises ~..: .~..i~I~.~..%~.:..~./,,~'~l~ddress ~.Ol~-~..p~l~i~.~ 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 oil 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.~tOJ~,~. ~ S S /~4_ ~ CO N ' ................. ~~~ ....................... being ~~d~igning contrec~ duly sworn, deposes and says that he is the applicant 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 thor the work will be performs in the manner set forth in the application filed therewith. Sworn ,o before me this ~ ~ . , 192~.T ~ ................... ~.. doy of ..7~,~ Notary Public,. .............. ~ ' -~-'~"':'"'~unty ....... .~.f~./.~...~ ....... f.~....-.~...~..~.~. · · 7 -'7~' ................ (Signature of opp,i;ont) .........................