The URL can be used to link to this page

Home My WebLink About7813-z FORM NO. 2 TOWn1 OF SOUTHOLD 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? 7813 Z Permission is hereby granted to: ...g~r~h~...Ltob.~hm .......................................... .......... ~thal~L ............................................... to ..g.~.~..c..~...~.~.~.~.&~g.,...~.~y..b.~ll~L~ ..~....uL~.t. ir~s .................................................. at premises located at .... ~.~..~;L.~L..~. ...... .~/~...O_~rt ....~m..]~?~l ................................................. ................................................ .S...o..u...t..h.,.o.~.~. ......... ~.,..Z.., .......................................................................... pursuant to application dated ........................AD,*II. ....... .1.0 ........ 19...~.~, and approved by the Building Inspector. Fee $. ~ .~......0..0. ........... Examined ...........V.....z ............... Approved .............................. !...! ..... , FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ...... ./..,.~..../... ~'~ ........... Disapproved a/c .... ~. ...................................................................................... ........................ ................... ............................ ~.~ .~.=.~ .......................... / (Building Inspector) J APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Tbs application must be completely filled in by typewriter or in mk and submitted in triplicate to the Buildinc 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 adjoining premises or public streets o areas, and giving a detailed desc ript~on of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm~ 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 Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY t~DE to the Building Department for the ~ssuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 t, admit authorized ,nspectors on premises and in buildings for necessary inspections. ~ 'g pp ' , or name, if a corporation) ........ ~o.u~thold... ]~.,.Y., ....................................................... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder Owner - builder Name of owner of premises .... '[).g.~'.g.fg~r...~gb.9~. ................................................................................................ If apphcant is a corporate, s,gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No. (~NER Plumber's License No ................................................. Electrician's L,cense No ............................................. __~_~-' 2--~ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ........ ~ ....................... Lot No .......x...x. .......... Street and Number ..01cl..~.~l-zm.~Rd...&.~J_ll..D. aart ............ SauJ~hoJLd.....N.,.~ .......................................... Municipality State existing use and ozcupancy of premises and ~ntended use and occupancy of proposed construction' a Exisiting use and occupancy ........... .~....G...o..~...~.~.. ............................................................................................. b. Intended use and occupancy ...... g..s:.r.~..e...~....~.....1...~n~.s..o..a..l~..i...n.~. ...................................................................... 3. Nature of work (check which applicaNe) New Budding ...:?.. ......... Addttion .................. Alteration ........... Repair ................. Removal ................ Demolition ................. Other Work .... ~.e~ J~...6'~fl .................. (Descnption) 4 Estimated Cost .......................................................... Fee .1. ~ ,. .0. .0. ..................................................................... (to be paid on filing this apphcation) 5. If dwelling, number of dwelhng umts ................... 0 .... 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 ...8,~,]::i.0.11'] 7 Dimensions of existing structures, 4f any: Front ......................... Rear ................................ Depth .................. Height ........................ Number of Storms ..................................................................................................... D~mensions of same structure with alterations or addmons Front .................................... Rear ..................... Depth ................................ Height ........................... Number of Stories .............................. 8 Dimensions of entire new construction Front .................. , ............... Rear ............................ Depth .................. Height .................. Number of Stones ............................................................................................... 9. S,ze of lot Front .... 1.&8..~../......20.9.6. .............. Rear ..... .~.9.0....~ ....................... Depth ....... ~j.cj...~. .......... 10 Date of Purchase ................................................ Name of Former Owner ...................................................... 11 Zone or use district m which premises are s~tuated l~m ~49¢6 ................................................................... ]2. Does proposed construcbon wolate any zomng law, ordinance or regulabon .... ~C~ ............................................ 13. Wdl lot be regraded ...~O ..................Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises .D. oz'.o.~c~r..2~.I~Z~. ............... Address .....~.~:t;;bO] Cl ........ Phon~ No ..................... Name of Architect ...................................... Address ................................ Phone No ..................... Name of Contractor .................s....a~.e. .................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~st,ng or proposed, and red,cate all set-back dimensions fro~ property hnes G~ve street and block number or descriphon according to deed, and shew street names and in&cai whether interior or corner lot STATE OF NEW 2(O~l~, COUNTY OF . .b.'..~..Z.'.Z:q.J...~. ........... ....................... .Ol¢%l&s.e,..~O]g. QbJZt ................................. being duly sworn, deposes and says that he is the apphcar (Name of mdiwdual signing contract) above named He is the ................................. ..~.g.e~.~.....o..~....o...~....e..~.. ............................................................................................ (Contractor, agent, corporote officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~erform or have performed the sam work and to make and f~ th~s application; that all statements contained ~n th~s apphcahon are true to the best of his knowledge and belief, ar that the work wdl be performed m the manner set forth in the apphcat~on filed therewith Sworn to before me th~s ......... ~" /' NOTARY PUBL,C, State et New Y~ ~ No 52 812fi~5q Suffolk CmJn!y~ /' Term £xp',rcs hlarch 33 19~'~.,~