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Home My WebLink About8344-z FOllM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: at premises located at ..~D.t..~. ........... .~..~O...(~:k.'eJ~:~%~J~ ..................................... : ........... ........................................... ~.. ~f~ik. ~..&. ~e ~.. ~ol ~...~ ~, .~ ....... ~ ~ ........ ....................................................................................... ~ ........... ~ ........... ,,.~,.. ;. ......... ~-.-..~...~ ...... ~.....~ ....... ~ 8uilding Inspector Building Inspector. Fee $..t ~,-~)~ .......... IPO~Mz lqO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19....~..). Permit No .... ~..~..S.~...~....~. Application No ...... ~..~....H.....~. .......... Disapproved a/c .......................................................................... ............................... ............................ APPLICATION FOR BUILDING PERMIT Dote ............. z/..~'., .~...~.. ................... 19..~.~.T. INSTRUCTIONS o. Thcs application must be completely filled in by typewriter 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 buddings on premises, relationship to adioming premises or public streets or areas, and gwlng a detailed description of layout of property must be drawn on the d~agram which ~s part of this application. c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll issue a Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or ~n 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 o 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. i ...... (Signature of applicant, or name, Jfa corporation) .... ........... (Address or applicant} State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electnc~on~ plumber or bu~Ider. Name of owner of premises ,.~,,z-/,~,,~...d,..~~ .................................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's L~cense No ............................................ Other Z rade's License No ............................................... ./ Street and Number - - ~"~ Municipality 2 State ex~shng use and occupancy of prerr~ses and in~.ended~use on~d-locc.u~toncy of proposed construction: a. Exisiting use and occupancy .................... ! ............................................... b, Intended use end occupancy ........................................................................................................................... 3. Nature of work (check which applicable) New Building ................ ^dd~hon .............. ,-~ ~ ,'t' Alter?on ......... Repair ............... Removal ............... Demohhor. ................... Other Work ......... ~ ....... : ............. ~ / UJe'~ ription) 4. Estimated Cost ............................. .~'....~.~:....~.~ ...... Fee ...............~..5...~...~....~. .............................................. (to be pa~d on filing th~s apphcat~on) 5 If dwelling, number of dwelhng umts .................... Number of dwelhng umts on each floor ...................... If garage, number of cars ................................................................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of ex~sting structures, if any' Front ......................... Rear ................................ Depth .................... Height ....................... Number of Stones ....................................................................................................... D~mens~ons of same structure with alterations or addmons Front .................................... Rear .................. Depth .............................. Height .................... Number of Storms ............................... 8 D~mensions of enhre new construction. Front .................. , ................ Rear ............................ Depth ................. Height .................. Number of Stories ............................................................................................................. 9 S,ze of lot. Front ............. /O..C,0. .............................. Rear ............. /..!~. ................. Depth ....... /..~.-../2. ........... 10. Date of Purchase ................................................. Name of Former Owner ........................................................ I 1. Zone or use distr~ct m which premises are s~tuated ........................................................................................ 12 Does proposed construction v~olate any zoning law, ordinance or regulation: ........................................................ 13 Wdl lot be regroded ..........,~ ............... .~/Will excess f~l be removed frpm p~e~es: ( ) Yes ( ) No 14 Nome of Owner of prem,se ~s~.4 .F~'.~~ Add ress ..~ ....... Phone No. ~..~.~...Z ..~./. ~ .J... Name of Architect ........................... Address ................................ Phone No ....................... Name of Contractor ............................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~shnctly all budd,ngs, whether ex~stmg or proposed, and indmate all set-back d~menmons from property hnes. G,ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot COUNTY OF .~.,/~..~.."~..~ ......... ~ ~ r ' h3 r ............ ~~.~.~]~ .......................... : ............. being duly sworn, deposes and says that he ~s the apphca~ (Name of individual s~gmng contract} above named He ,s the ...................... ~ ...... ~"' Td~nt~cto'""'--~,__~__ ~ .~..~ ~_..~_, _.~ .a"'-%~k~',";'oZ~;~;~'~f;;C';"~Z'< .................................................. of sa~d owner or owners, and is duly authorized to Perform Or have performed the sa~d work and to make Qnd ill: th~s applicahon; that all statements contained ~n th~s apphcotion are true to the best of his knowledge and belief; tk, a~ the work wdl be performed ~n the manner set fodh m the opphca~on filed therewith. Sworn to before me th~s ....... o, ...... , . Nota~ Pubhc, . ......................... ~.~.[Z~.. Coun~ /~ (Signature of applicant) [LIZABETH ~NN ~[VILLE ~o 52RI25gS0 Suf/cl~ C~unly