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Home My WebLink About8215-z F01~I NO. ~ TOWN OF SOUTHOLD BUILDING 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? 8215 Z Permission is hereby granted to: ~:...;..~;~..~.....,~:?.C_.,.~.:~.....:~...o......; .~/.y....¥..t!..~.L~...~.y..~..~ ................. !'! :.:..~: :~.~::,~ ~ ¢..~. ......................................... at premises located et L¢.t,...l.66 ........ Ca.p:L.J~l.d~J..~$~; ............ .....: ................................................... .............................................................. .C.'.~ ~..t....r~ ~ ~...~ r.% y.e ........ ~.~.~.$.¢..~.~ .....~.~..1(..t ................... ................... ~)..~.....~.~. ................. , 19~.~'..., ond approved by the pursuant to application dated Building Inspector. Fee ~...L~...~.g ......... I Building Inspector J FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ICAT Date .................... .~. =.....c~....~_ ............ , o. This opplic~tion must be complotel~ filled in by ~powritor o~ in i~k ond submitted in tripllc~to to th~ ~uildin~ Inspector, with 3 ~ot~ o{ plans, ~ccurato plot plan to ~1o. Feo ~ccord~n~ toschedule. b. Plot plon showin~ Ioc~tion of l~t ~nd o~ buildings on premises, re~otionship to ~d~oinin~ premises or public slreots oreos, ~nd oivino a detailed doscription of I~yout ofproper~ must be drawn on the dio~rom which is po~ of this ~pplication.~ c. Tho work covored by this opplication may not bo commonced bofore issuonce of Buildin~ Permit. d. ~pon opprovol o{ this appllc~tion, tho Buildino Inspector will issue o Buildino Pormit to tho opplicont. Such permit~ sh~ll be kept on tho premises ~wilable {or inspoctlon throuohout th~ work. e. ~o buildin~ short be occupied or usod in wholo or in port {or ony purpose wh~tover until o Co~i{ic~to o{ ~cupancy~ sh~ll hove been orontod by the Buildin~ Inspoctor. AP~klCATIO~ 15 HEREBY ~ADE to the BuildinO Deportmont for the issuance of o Buildinfl Pormit pursuant to the ~uHdino Zone Ordinanco of the Town o{ Southold, Suffolk Count~ ~ew York, ~nd othor applic~blo Lows, Ordinoncos or Re~ulotions, {or the construction o{ buildinos, odditions or olterotions, or {or removal or demolition, *s herein described. The ~oplicont ~rees to comply with aH ~pplicoble Iows, ordinances, buildino c~e, housin~ c~o, ~nd regulations, and to odmit outhorized inspectors on premises ~nd i~ buildings {or n~ess~ in~ections. {Sionaturo o{ opplic~nt, or name, i{ o Corporotion) State whether applicant is owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder. Name of owner of premises ....... .....~~ ........ ~-~.. ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~..~,~,,77--..~ .......... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. MapJ~o.: ........................................ Lot No .......... .~.~,~.. ....... Street and Number ..... ~..~...~.: ............ ~/:~ ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............ ~ -- ..................................... b. Intended use ond occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior. .................... Other Work ...... ~..~ ............. 4. Estimated Cost ................ ?.../..~...~.Z..-? .......................... Fee /~ ~ (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, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additioas: 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 ............. .'.~....~....O...~ .............. Depth ....~ ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Nome or Architect .............~ ............................................... Address ................................ Phon* No ....................... Name of Contractor ............................................................ Address ................................ ~hone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names end indicate Whether interior or corner lot. STATE OF NEW Y,,~RK,~-- COLJj~FY~~..~,...__ ///_OF ..~~/~ ~'~ (Name of individual signing contract) above named. He is the ..................... ~~~ ................................................ (Contractor, agent, corporate offiger, etc.) ~ ys that he is the applicant of said owner or owners, and is duly authorized to perform or have performed the said wcrk and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed theJ~with. ~ Sworn to before me this -- , -- /) ,,~ -- /J /~ ....... ~.~.... day of ~.~.~: ......... , 19~. //~/ /7 ~/ ~ ........................... ..................... (Signature of applicant) · NOTARY PUBLt(], State of New York No. §2,8125950, Saffolk ~ou~ty term [xpites k4arch ~o. 197.~