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Home My WebLink About7814-z FORM 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? 78i4 Z Permission is hereby granted to: ............... Q~±ez~t ................................................ to ..... er.e at..£encin $.... as..~er.., ap~li~a.t ~o~ .................................................................... at premises located at ..1~._-I~ ~.l~oa~ .....~.~L~2.~) ................................................................................ pursuant to application dated ......................~f]. ....... 1.0. ......... , 19.~.~..., and approved by the Buildin~ Inspector. Fee $..1. ~.~..Q.Q ........... Examined Approved ............................. Z..~......, ............................................................... ~n~ inipect~il~ ........ ............... ............... TOWN OF SOUTNOLD Z~/~ _ ./~., ~ ~ BUILDING DEI~ARTMENT TOWN CLERK'S OFFICE ~~ ~ ~' ~OUTHOLD, N. Y. ,o. ............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submmtted in triplicate to the Buildin_, 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 adjoining premises or public streets o, areas, and g~vlng a detailed description of layout ofproperty 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 Bu,ldmng Permit to the applicant. Such permil 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 thc Budding 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 atterahons, 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 tc admit authorized inspectors on premises and ir~ buildings for necessary inspections. ........ ~l na -u'r~l.i-~ .c~.r~t,~'r~..r~ .a-~'~,~i f ..a.~.~ .o.; .p..o-r .c~,, .~ .n.i ........ (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner at premises ....~'...~...~.:.~..' ..../_,/~....'TT~:~ .................. T. ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~.?...~....~../. ............................. Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~. ~ Locahon of land on which pj:oposed work will be done Map No ......................... Lot No~ .................... Street and Number .... ~......~...~' .................................................................. .~...~ .................. Municipality State existing use and occupancy of premises and re?ended use and occupancy of proposed construction: a Exis~tmg use and accupancy ..~c~ ~ ...................................... :3. Nature of work (check which applicable) New Building .................. Add,hah ............... Alteration ......... Repair .................. Removal .................Demolmor .. . Other Work .... .'.~..~ .................... '~'.~~/./~ ~ ~ / ~Z..~ (Description) 4. Estimated Cost ........ ....:..:.=..=. ................................. Fee ...~. ................................................................. (to be pa~d on filing th~s application) 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 Dimens,ons of ex,sting structures, if any: Front ..... .~..?..~ ........... Rear ......~...?..~ .................. Depth ...~..?..~. ...... Height ....?...0..°. ............ Number of Stones .... ~..~.. .............................................................................................. D~mens~ons of same structure with alterations or addmons Front .................................... Rear ..................... Depth ............................... Height ...................... Number of Storms ................................ 8 D~mensions of entire new construchon: Front ................ , ................ Rear ........................... Depth ................ Height .................... Number of Stones ....................................................................... 9 Size of lot. Front ....... ~.. .............................................. Rear ....~.~...~ ......................... Depth .....j.....~....O...~ .............. 10 Dote of Purchase .................................................... Name of Former Owner ...................................................... 11. Zone or use dmstnct in which premises are situated ~.' ......................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation' ..~...'. ........................................ 13 Will lot be regraded ........................ Will excess fill be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premlses~.~...~<w'k.,~-':~-' ~ ......................... Address ~---~~......~g-- -- Phone No Name of Contractor ..... ~ .~.~ .......... Address Phone No. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and Indmate all set-back dimensions fron property hnes Gwe street and block number or descr~phon according to deed, and show street names and in&cat- whether interior or corner lot , 41 STATE OF NEW YORK, I COUNTY OF .......................... fS S ........................................................................................ being duly sworn, deposes and says that he ~s the opphcar (Name of indiwdual sigmng contract) above named He ~s the ......................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the sa~d work and to make and fi th~s apphcation; that all statements contained m thru apphcat,on are true to the best of his knowledge and behef, ar tha~ the work will be performed m the manner set forth in the apphcat~on filed therewith. Sworn to before me th~s ......... ........ of ......... ........ , Nota Pub,c,. ..................... ....... ........................... ~ , //~ , ~ (Signature of apphcant) / ' ~'-~ ~/~'~ NOTAi~/? PU[;LIL', State r~ ~!',,~ York / / Suff~Jlk County - ['.,~. 52 9176~95 ~// ~erm [.xplres ~lar~h 30. 1976 .