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Home My WebLink About8066-z FOEM NO. ~ TO~N O~ $O~THO~D 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) N.o z Permission is hereby granted to: · ¥~.t.~'~.bu~k ................................................. to ..... ~ ~.~ t...£ ~e.~ .. ~I~.~... ~.r.~ $~.~ ~ ...... ~.IL~.- - · ~ ~ -a .i.~. · -_~. ~ ~i ........................................... at premises located at ...~.J:ri-..~ .................................................................................... ............................................... ~.~.~t, ~.~ ~ .~k.-... ~... ~. ,. ............................................................................ pursuant to application dated ..........................,~;t~.]~-y. ...... .C~ .......... , 19.~.~..., and approved by the Building Inspector. Fee $.L.~..;.:O ............ ' ' Building Inspector / Foams NO. Y TOWN OF SOUTHOLD BUILDING 'DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. C Examined ....... ....�. . ., 19.�:� Application No. ..C'..................f Approved. . .......................�.Q. ., 192.... Permit No. .................................... Disapproveda/c ................ ..... ............. .... ..................... .............. .................................................................................. .............. ............... ...... . ............ .E .... ng.Inspecto. ................................ APPLICATION FOR BOIL N(G PERMIT n Date ................../..'... ............... .. INSTRUCTIONS . c1 d a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Build'fbg- 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 onpremises, 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. c. The work covered by this application may not be commenced before issuance of Building Permit. c 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 1Z shall have been granted by the Building Inspector. a 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. (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. ............... .�. :...- o ................. .... ........ ...................................................... .. ..... .... ...... .... Nameof owner of premises ......... ........ ........................ .' ...:..............................................................�..... If applicant is a corporate, signature of duly authorized officer. ....................................................................................... (Name and title of corporate off f iiccer) Builder's License No. .... �°"^. ..l►.�•::�."��''..... . Co Plumber's License No. ................................................. Electrician's License No. .............................................. OtherTrade's License No. .............................................. 1. Location of land on which proposed work will be done. _Mqp No.: ................ ....... Lot No: . ............... Street and Number ...............1...1�.C—".. .L.......... ... .RV.......... . ( .. .. .......C_/h,. ........... .......... Municipality 2. State existing use and occupancy of"emsesnd intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... ....................... ...... ...........................................,. b. Intended use and occupancy ............... ...................... ..........c^..-:` ............................................. 1 / . 3. Nature of work (check which applicable): New Building. ------. Addition ----.. �"Alteration ................. ' Repair .................. Removal ------ Demolition.................... Other Work -- (O ,— e�cr��G� 4. Estimated Cost ............................................................Fee .---^ — --� -'-' --_----------' (to be poid _n fiUngVis application) 5. If dwelling, number of dwelling units ............................Number ofdwelling units on each,floor —'',..------ |f garage, number of cars _----.--_—'.---'---'--------'----'-----_-_------'---.---- 6. If business, commercial or mixed occupancy, specify nature and extant 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 --.------- Daoth ................................ Height ---------.Nunnber of Stories —.---------- 8. Dimensions of entire new construction: Front -------,-----' Rear ............................ Depth ........................ Height ------.' Number of Stories ...................................................................................................................... , . � �� -��-/ 9. Size of lot: Front ------..�—��----.-----' Rea r ---��!��.��------.. Depth —�—,��.-----' lO. Ooto of Purchase ........................................................Name of Former Owner —.-_--_-.—.'--_'---_----. ^ `l. Zone or use district in which premises are situated -------.—.---_—.—.—.—.--_--.----------. 12. Does proposed construction violate any zoning low, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( } No 14` Name of Owner of premises�� . v� ��m`{��--. k� �4:... Nameof Architect .............................................................. Address ................................ .Phone No ...................... Non`e of Contractor ---------------'----' Aujdreoo ................................ Phone.No ....................... PLOT O|/\GR/\k« ' � Locate clearly and distinctly all buddings, 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 whether interior orcorner lot. 176 STATE OF NEW/J(CIR t u\ . � � ��.x being duly sworn, deposes and says that he is the applicant (Name* of individual signing contrzcf ' above named. . . � He is the ------..��.�—�..�.��:..c.-------._--.--------_----_._________._________ (Contmctor, agent, corporate officer, etc.) of said owner or owners, and is duly utho ized to perform or have performed the said work and to make and file .this.oppiicotiun;..thot.oU'a1o1nnents.cont�|—� |n'th� gPP - - `7�� orne��ws��t6��.ry/E�U]esqR9 belief; and thar the work will be performed in the manne.,r fo�h the f||e6�k6,b Sworn to before me this day or ... _� /xvm/y Public= ,^y �,__._................ ___ _____________________ (Sig otbre ofapplicant) 6� �] EUZ ocT/ «wN mcvIL/ -v nv/axr poour' wow of Now York No. 52-8125890. Suffolk county