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Home My WebLink About7683-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7683 Z Permission is hereby granted to: .......... 200.....Ge~e..l~m& ............................... ...................... t~w...~u~£.~l~ ............................... to ..Ln..?.~..1..l.....a.~...~ .....~.. ~.t.~ ~ ..~.~. ~.7..~...~t.gh ..c.~z~ ..1~.. ~.~.e ........................................ at premises located at .....G~:&e..~o~d..~..~.:~cl..~tz'~e.t ........................................................... ................................................ ~.e..~...~.~I.:.~. ...... ~..,.~.,. ..................................................................... pursuant to application dated ..........................~.~..~.......~. ................. , 19...~.~, and approved by the Building Inspector. Fee $.1.~{.~ ........... BUILDING DEP*RTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application ,.,mlt No. S APPLICATION FOR BUILDING PERMIT .............. ......................... , Date0./ ~ ~ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot and of buildings on premises relationship to adjoining premises or public streets oF areas, and giving o detailed description of layout ofproperty must be drown On the diagram which is port 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 o Building Permit to the applicant. Such permit 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 Build ng 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 here n described. The applicant agrees to comply with all applicable laws, ordinances, building code,?ousing code,/~d regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectiprl'sTM.~/' ~' ~r (Signature of ~'l~plic~'r~t, or name, if a corporation) ................................ ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duty ~uthorized officer. (Name and title of corporete officer) Builder's License No ..................................................... ~ Plumber's License No ................................................. Eiectrician's License No ............................................. ~, Other Zrade's License No,;z_ ~ c~/ .............................................../~_~ ~ X~,~/}~ ~.... ~..~.i 1. Location of land on which proposed work will be done. Map No.: ............................. Lot No ................... ~- ~ ~.~¢c~ . .. Street and Number Municipality 2. State existing use and occupancy of ~m,~ ',s~ iln~ i~.,~n.~,ended use and occupancy of proposed construction: a. Exisiting use and occupancy .... ~.~..~....~....~ ........ / .. , ' ......... b. Intended use ann occupancy ................................... ..../..... ........ ~..~.t.~....~ .........:. ........... ~ .............. .t ......... / 3: Nature of work (check which applicable): New Building'. ................. Addition .................. ,/x __ / .o~LAIterati°n ............... Repair .................. Removal .................. Demolition ................... .,Other Work ..~...i/:..O.~.~.....~..~/~../..~....~..,./..Xf'..~'..Jf~.T.~r~ // / / 7/ ~-- (Description} 4. Estimated Cost .~....?....~_..~. ~), ~ d Fee '~"~?e 'p~l~ ............................................................................... ~ ......... .... ......... ~ .......... y....; ....................... n fdmg th~s apphcat~on) 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 .......... Z.~ ............................. Name of Former Owner ...~.~.~.~.~'...~.~.~.~~ -- ~''~--~-- 11. Zone or use district in which premises are situated ..................................................................................................... ~.12' Does proposed construction violate any zoning bw, ordinance or regulation: ........... ~.~'. .................................. 13. Will lot be regraded ......: ..................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. N~me of Owner of premises ...~..Q ~~ ~ ~'~Add ress . Phono ~ ~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~.l.~.~.}l.~.~......~....~ddress .~l..~.~ff.~.~ ..... Phone No..'~.~ZZ~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. ~ ~ ~ ~ STATE OF NEW YORK, COUNTY OF ............. .,~.. ~..~.~ .~.G ./:~. ~ ~ ', ,~ (Name of i~ividual signing contr~'~'i ................. above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowled~F and belief; and tha~ the work will be performed in the manner set forth in the application filed there, with. z // Sworn to.b~fore me this /] Natal Public, . ............................. Ouohfied ,n Suffolk Count'/ (Signature of applicant) Term Expires March B0,