The URL can be used to link to this page

Home My WebLink About8107-zDispppra ,ed a/c ................ l ~) y l ~) APPLICA?IOfl FOR BUILDING PER~'? ,~ · .~...~ Date ..~..L/i~-./.. ............................. , 19. ge in ink and ~omitted in triplK~te to the Building a. This application must be completely filled in by .type, writer . . . In~poctor~ with 3 ~ of p~ans~ accurate plat plan to I~am.. rea ?ccon~ng to scchedule. . Plat plan showing location of lot and of butl~ing~ an prern~?es, relation~..Jp ~ gallo,nj .rig..p)~m. me,.or,., .~ ~.re~.. areas, and giving a detailed description of lay~t.oft~l~/must be drawn on The alagram wnion ~ pan m m,s al~ncormn. c. The work covered by this application may nat be commenced before issuance of Bu!lding Permit. . d. Upon aPProval of this application, the Building Imbec.tor wil! issue .a Building Perm,t to the applicam. S~¢h berm,t '~ shall be kep~ an the promises available for Ir~paction thraughom the wor~. 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 I$ HEREBY MADE to the Building Department for the issuance of a Building Permit purluant to tho Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ..other applicable laws, Ordinances or Regulations, for the caP. struction of buildings, oddltlom or alterations, o.r for removal or demolitlan, a~ he[e. in ~clesc. o~be The applicant agrees to comply with .all aPPlicable laws, o_rdinances, building code, h(~,~g code, and regul~, to .................... ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ........................................................................................... i ................................................................ Name of owner of premises ....~....~.....*~..~....~..~.....~.~.-.~...~..~,~ .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Licmse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Tmde's License No ..................~ ..................... / /~ ~t '-~''~~~1~ 1. Location of land on which proposed wolff, will be done _Map No:: ~'/.~....~...~..L,~~.....,.. .................. Street and Number .~.~.....~./..~..~..~.~.~....~~-- '' ~--- ......... i..~;.:....~.~..~..~.'~' .~..~..i....~ ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of prapoeed construction: a; Exislting use and occupancy Z~ b. Intended use and occupancy ....~..~ ....... ~-~....~.........-.~'~'~..~....'~'...~..~.~.-.... .~.~""~" .......... 3. Nature of work (check which applicable): New Building........-..~.. :... Addition ......~. ......... Alteration ................ Repair .................. Removal .................. Demolitior. .................... Other Work ...~..~'..-~......'~......~..~ ...... (Description) 4. Estimated Cost ...... ..~..~...~.....(~... ......................... Fee ..... ~....~....~..... ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... :.'.".::. ............... Number of dwell.ing 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 ........ 7~,~.....Number of S~ories ....... ~ .............. 8. Dimensions of entire new construction: Front ......... ./.~..~... ............ Rear ......... ./..~...~....... Depth ../.~....~.....,~.. ..... Height ...... ~...~ Number of Stories ...,....'~. .......................................................................................................... 9. Size of lot: Front ................... /.~......~ ........... Rear .......... ./.~..~ .......... Depth ..../...o~..~......~.....~'.. ....... 10. Date of Purchase ........... ./..~..~.....~.. ....... ' ...................... Nome of Former Owner ..~.;~..~'~..?... ....................... 11. Zone or use district in which premises are situated ...... ~......~...J~... ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~....C~... ...................................... 13. Will lot be regraded. ...... ~;;; ......... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~..?.~..~..~'.~..~./. ~/~,~.....(~....~.~dress ..~..~..../Z'.../'Z~.~.~..C,-Phone N0/~.~....~.....~...~. 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 all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. above nam~. ~ He is the ....................................................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly a~rized to pe~orm or hove performed the said w~ and to ~ke and file this application; that all statemen~ contain~ in this applicati~ ~ tree to_the ~t of~wled~ and beli~ and tha~ the wOrk will be Performed~n the ~anner ~t fo~h in the ~pl ~i~ ~le~r~ Swam to before me this [I ~ ~ .......... ....... . ....... .......... No, 52.~703725 Suffolk County. Camm. Expires March 3Q. 19~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, Iq.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8107 Z Permission is hereby granted to: adzi,?,!s:~:.....i:~,J~!aj.cz~.l~ .............................. 'F~ ....... ~.o~...~.~.Q ...... ,~ ...... ~ ............................. to ..~;~.~.:t..¥~z~..af:~.~,;.~az~...f.~.~.~.g.~,..b.~2.d~m~ .............................................................. at premises located at ~.~1%~ ~oa8 l(~ttli~tck pursuant to application dated .......................... 19...1.;., and approved by the Building Inspector. Fee SJ..O..t~.(.: ............