The URL can be used to link to this page

Home My WebLink About7772-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP,'EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7772 Z Permission is hereby gmnted to: ............ ~a.tt &t~k .................. : ........................... to ..... ~.e~.t.. ~n~,..ma~,~ .. ~t,o~keA e...£eno .$nl~...o~ ..~/...P~.s.- 6 L .$re~¢-..o-~ .. ~ouee ~;o ...... .~.q.~/~...P;t'... ~.O:p. eg'J; ~. .................................................. ................................................................ at premises located at ....~,,,~.e2.?...&..]3e~'-]:.y-.,q~...(.~.V~...R~...) .................................................... ................................................ S~u~;ho3~.....N.~., ............................................................................... pursuant to opplication dated ........................~'~.q2.~....~ .......... , ]~..~ ...... and approved by the Building Inspector, Fee :~ ~., .O.C} .............. Building ~Insp' ector / FOF,,M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ..... (M:.~. .... ~. ....... , Approved ............... ::;- ......... :.~ .......... , 19 ........ Permit No. '~-) 7 ~ ~ .sapproved a/c ........./.~:.....~ .......... ~...~ .............. ~ .............. (Buildino lnspoctor) [ ............... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building 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 oF areas, and giving 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 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 Building Permit pursuant to th~ 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 herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tp admit authorized inspectors on premises and in buildings for necessary inspections. - (Signature of appli~;~;7'~;-"l~'~';7'i~"~"c'~'~l~'~i~'~ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ,~'7.~)./~J./~..~.~ ....... . .~..~..~..t~..~.~ .............................................................................. if opp)icont is o corporate, signature of du~y authorized officer, (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Locot on of and on whj~b.~oj;zosed work ~ilLbe don~Aap No.: .................... ~ ~o~' Nr~ t ~ arreer aha r, lumoer ............................. . Municipality State existing use and occupancy of pre,raises and i~p~tended us~e and occupancy of proposed construction: a. Exisiting use and occupancy ................................... ,~, .......... /.. .............................................................................. b. Intended use and occupancy .................. ~...~./...:~,~.:.~...~ ......................................... property lines. Give street and whether interior or corner lot. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work ....~E..~..../)~....C:...!....k~....c/.. ................ . .... (Description) Estimated Cost .................. : ............................. ' ............ Fee .......................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ..... , ...................... If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... Size of lot: Front .............. .~..-...~.. ................................ Rear ............./_..~..~ ......... ~. ........Depth ...... /..~...7. ................ Date of Purchase ........................................................Nome of Former Owner~. .......................................... .~/,.~. ..... Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Wi[[ lot be regraded . ........................... W~ill excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises .~.~..b..~.)..~...l~..~.....~..~..~....~...?....~..-- -- '"~- ....... .. Address ....~...~..~..'...'C.../'I......~...~... Phone No.)..~...~;.:./.~(.~. ..... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ............................................................ Address ............. : .................. Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ndicate all set-back dimensions from block number or description according to and show street names and indicate STATE OF N F~'~, Y~,~x///~ ( c c COUNTY OF~ ~..~.. .......... ~'~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) a'bove 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 knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn t~ b~f6re me this ~ ~,~ , , / ~,--~ ~-~ day / /, J. , ..................... ? ' K~N / (~a~ature of applicant) N(, 5~, ~)~44263 SuffoJk Counb'