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Home My WebLink About8141-zTOWN OF SOUTHOLD BUIkDING 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) N? 81~1 Z Permission is hereby granted to: ..... :~.e..z...o... ~ .% .~.~.% ...................................... ..... ;iJa~..A~e .......... C~ .......................... to ...~:,~L,O,...u.¢~li~. ....... ~.¢.~a~.~.....~3.~-~g ...... .@...~a~...b~a ..................................... at premises located at .......... ~/~..~..~..~.....~.~I~ .~lk.-.~l~.) ........................................................... .................................................. ~,~ehograe.......~.,~.~ ....................................................................... pursuant to application dated .............................. A~'"'"~'~ ......... , 19.~1~.., and approved by the Building Inspector. Fee $..%Q,.O0. .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .... ........................................ , ..... ..,..,. ..... ..= ....... Applicatian Na ............................. '~RMIT Date .......................... El ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 adjbining 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. 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 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. ........ i~i~'~'~'i~;'~"~'~[;i'i'~i"~;r name, if a corporation) ' . .................................. (Addreg~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~ ..................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propo, s~ed work ~w~l~l be done. ~Map No.: ..... ~,~, ......... />....../z ............ Lot No ......................... Street and mumDer ......... ',..t.,.~, ......... ;..~ ....... ~....>,w.',;.; ................ a~; .......;.- ........ ;,~;.~;.~- ......................................... r , Municipali~ State existing use and occupancy of premises pnd intended us~nd occupancy ~ proposed construction: a, Exisiting use and occupancy ............. ~ ....... ~..~.~..~ ......... ;.....L...... ....... :,~.......~ c;~.'.......'~....;....:..'L,fi.... ..................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demofitioc .................... Other Work .................................................... (Description) 4. Estimated Cost ............................................................ Fee ..... /"(~[~"~'~"~c'i¥i~"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 ..................... 7~...,.~.... Rear ......... ~....,~ ............. Depth ....,~.:cd .......... Height .................... Number of Stories ....... ~..-T.r..%~ ........................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....,~...l..'.'-- ......................................................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation: ...... /..~.,.....r. ........................................ 13. Will lot be regraded ........./.?..~. ?. ......... Will e~c~s~c~L..be removed fram p,r.e~m~L ) Yes ( ) No 14. Nome of Owner of prem,ses. ':.?y~-'~'--'~....k.)'.': ddress ....... .(',~.~;. .;...;;;. Phone No ....................... Name of Architect .............. ...>,.~.~. ........................................ Address ................................ Phone No ....................... Name of Contractor .......... .~.-..~-,,.x*~....; ................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. x' ,,_.. ,,/. /'(/, COUN'FY OF (Name c~r~ i~3ividu~l~(gning contr~cf) NOTARY PUBLIC, ~tete of Newl fork No, 52-81258511, Suffof~ ~Ol~nty T~m Expires March 30. duly sworn, deposes and says that he is the applicam above named. (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 tho~ the work will be performed in the manner set forth in the application filed therewith. Sworn to befqre, me this ,~ -) - ~ .. ~.. , ................... ,J...~day of ...;~.,.~.....!.,,Z'~, .~/:~ ............ , :9....."...' , ~, ,- :'--~ ~ r Not., Pub, ic, ......... ..... Cou, , ........ ~-~'~0 '(--~/~/~ ~[ ~ (Signet,re of applicant) "~ ELIZABETH AN'J~' NEVILLE