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Home My WebLink About8176-z ~ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8176 Z Date ......................... ,~G])~.....3 .............. , 19.~.. Permission is hereby granted to: ~amu~-.~a~-....~....'G~'~'e~m~"M~ml~ak&m · ...3~-k& ....... 3~..8~ ....... *s tm-~.....~i.~.'/.~. ...... .............. ,..tm..~s~b;Le .. eo~41.tie~ .................................................................................................. at premiss I~at~ at ..... ~'l~"~e'"8~ ........................................................................................ .............................................................. ~p~.t ....... N..~.. ........................................................... pu~ucnt to appl{cation dat~ ........................ ~p~.....~ .............. , 19~..., and app~ by the Building {n~tor. Fee $.~,$.00 ........... BUILDING DEFARTMEHT TOWN CLERK'S OFFICE .~. soumou),,. Y. ~/~ ~ ~ '~ ~ ~ Application No ................................. Examined ........... ~ ........ , 19...:.--/~ ~/ 7 ~ ~ Approved ........................................ , 19~..;.... Permit No ..................................... Disapproved a/c~..:.>..~,~ ..................... ~-~ ....................... 12 ........................................ ~ ......... ................................ ~,'.Y~'/l¥~"i;;~g;i ................................. ^.-,~T,o. ,oR .U,LO,.~ .,.~,T ~t. ................. ~......~...... ~%..-..... INSTRUCTIONS a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plat plan to .cole. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship t.o. adjoining, p. re. mises or. I~..blic st..ree.~, or areas, and giving a detailed d--scription of layout ofprpperty must be drawn on the d,agram wh~cn = part at th,$ appncat,on. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Build!ng Inspector wil! issue .a Building Permit to the applicant. Such permit shall be kept on the premises available for Inspectmn 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 o. oplicable L~., Ordinances or Regulations, for the construction of buddings, additions or alterations, or tar removal' or demolition, as ne.rein descri .bed. The applicant agrees to comply with all applicable laws, ordinances, building co~e., housing code, and regulatlom, and to admit authorized inspectors on premises and In buildings for necessary Insl~/,ons. '~'i~:ignature of app icont, or na;~e, f a t~ll~i~'~ ........ (Address of applicant) State whether applicant is ~n~er, lessee, age~/architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~ ........ Z~f,~'....~r~. ~ ..... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Licanse No. ~'~"~-'~-'~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... o Lot o /)[ 1. Location of land on which proposed work will be done. ~o.: ................. .~ .~... ............. . N ..................... Street and Number .... ..~...!....! ....... ~.!~ ...~-~- .............. ~:~.~.~ ................................... o. Exisiting use and occupancy ...... ~..~.~...~...~7_..~ .............................. ,~ ............................. ~ ............ b. ,nte~ u. and occupancy ........................................ ~. .................................................... ~:~ .................. 3. Nature qf.work (check which applicable): New Building.. ................. Addition .................. Alteration ....~/.. .......... 'RePair .,,~,,~ ...... Removal .................. Demolition .................. ;. Other Work .................................................... 4. Estimated Cost ............................................................ Fee / ~ O O . . (Description) (to be paid on filing 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10~ Date of Purchase ...................................................... ,N~me ~ Fo, rm~r Owner ...................................................... 11. Zone or use district in which premises are situated ...'.~.' ......~ ...................... " 12. Does proposed construction violate any zoning law, ord nonce or regu ation: ....... ~..~. ...................................... 13. Wil Jot be rearaded ~ ............ :,.; ........... .~i~,exce,~s fill/be_ repoved from premises: ( ) Yes~_ I~ No ]4. Name of Ow~;~[ of premis~s.~.~...,~.~ .~...~clress ..~../.~..~.6..:..~?....~.. Nome of ]~?t~qct~-'~'~~...- [ ,~,." (~l/,~ ( .~--;,.,r_ ' ............ ...... A~.... ..~<:~ ~-,~- ' ' - ........................................... ,., ,., Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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 N~ ~ ¢ c ........ : ................ ~ ....................... ;.~.~ .................................. being duly sworn, d~oses and says t~t he is the applicam (Name of individual signi~ c~trac~ o~ ~oid owner or owners, ond is duly outhori2~d to p~rform or h~ p~r~orm~d th~ ~aid work ~nd to mk~ ond thi~ oppllcation; that ~11 *t~t~m~nt~ cont~in~ in thi~ ~pplicotlon ~r~ tm~ to th~ best o{ hi~ kn~l~d~, th~ tbe work will be p~rform*d in ~be m~nn~r set {o~h in th~ opplic~t~on Sworn to ~ me this ~ I ~ ~ ~ - / / - (Signature of applicant)