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Home My WebLink About7773-z FORM NO. 2 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? 7773 Z Permission is hereby granted to: ~.~.~..~ .o.r~...E~.~ .~....q..o,...~L.a....~r.~a~.~..~....~r.~h~ .................. ~/ia.t,t :Lt m;~k......: ................................. to ...... F~e.c:l;...n~w...;~ma~.. ~.. 2~a~.LL.. £ez~e~ ...1+2,!!.. a~.. ~..S~d e...B.,~., ..&..6i'.~.. h~ka~ ~eav® ............ ,On..~..R~L~ ........................................................................................................................... ot 9~em~ses ~ocoted ut .lOt..~. ................ Fle~tfie~ ...................................................................... ............................................ ;~el~..~o~d ......... O~e.~o=t ................................................... pursuant to application dated .........................~V.....2~ ............. , 19..~.~., and approved by the Building Inspector. Fee $...'[ ;.~,~.0.0 .......... TOWN OF SOUTHOL'~..-~ ~ ? ~,c' ~ ~'~-" TOWN CLERK'S OFFIG[a'~. ¢~'~ . '-- Application No fi? Examined ........ : 19.~.~ ~~'~ ................. ~proved ........................................ , Permit No ~.. Disapproved a/c~~~~.~ .................................................................... ........ ........................ ................................. APPLICATION FOR BUILDING PERMIT .......... ........... ......... o. This opplication must be completel~ filled in by typowriter or in ink ~nd submitted in triplicoto to tho Buil~infl~ Inspector, with 3 sets o{ plans, occumte plot plan to ~olo. Fee occordin0 to schedule. b. Plot plon showin~ Iocotion. of lot and of buildinos on premises, relotionship to ~oinino premises or public streots ~reas, and Oivinfi o det~ilod description o{ I~yout o{property must be drown on tho dioorom which is port of this opplic~tion. c. The work covered by this opplicotion m~y not bo commenced before issuonce ofBulIdin~ Permit. d. Upon opprovol o{ this opplicotion, tho Buildin~ Inspoctor will issuo ~ Buildin~ ~ormit ~o ~he ~pplicont. Such permit~ sh~ll be kept on ~he premises ~vo~lab[e for inspection lhrou~fiout the work. e. ~o buildin~ sholl be occupied or usod in wholo or in port for ony purposo whatever until o Certificolo o{ Occupancy sholl have been ~rantod by the Buildin~ Inspector. APPkICATIO~ IS H[R[BY MADfi to the Buildin~ Doportmen( {or the issuance o{ o Buildin~ Permit pursuont to the Buildin~ ~one Ordinance o{ the Town o{ Southold, Suffolk County, New York, ond othor opplic~blo k~ws, Ordinances Re~ulotions, {or the construction o{ buildings, oddltions or olterotions, or {or removal or domolltion, os herein described. The opplicont o~rees to comply w~th oli opplicoble Iows~ ordinances, buildin~ codo, housin~ code, ond m~ulations, ~nd admit ~uthorized inspeclom on prem~sos ~nd in buildin~ for n~esso~ inspoctions. (Signature of applicant, or name, if a corporation) (Address of appffcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. .......................................................................................................................................... Name of owner of premises ...... .~....~..~ .~?C-.J..~. ....... ~......~.~.~.~..~..~ .......................................................................... If applicant is a corporate, signature of duly 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 ............................................... Location of land on which proposed work will be done. ~LAap I~'--: ...J.~,./~.~T.~..~..~.~,/~..,.. Lot No ......................... Street and Number ....~...(~.......H...L.~..~.~..~...'~..~...~........~...~..~ ................. ..'~.~...~..~.~..~....~.~..~..;..1~.. ............................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .O...~..D..~...- .~...?.[,.~....(.J..~.. .................................. i ........................................ I b. Intended use and occupancy .......... ~/'~l ............................................................................:1 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair Removal .................. emohhon .................... Other Work "'~"'~" 'J~" "~"/'"4' · · (Describing')' ...... "' 4. Estimated Cost ............ .~...~'.....~_ ................................... 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, 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 .........../..~..6 ..................... Depth ./...¢~...]. .................... 10. Date of Purchase ........................................................Name of Farmer 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 14. Name of Owner of premises ....... ,/~.....J.,~....~,..,...7~,.~......~. .......... Address Name of Architect ......................... i Address ................................Phone No ....................... Name of Contractor Address ............................. Phone No ....................... ' PLOT DIAGRAM Locate clearly and distinctly all buil~ existing or proposed, and indicc ~ all set-b~ck dimensions from property lines. Give street and block s~ ow street names and indicate whether interior or corner lot. STATE OF NEW.~YOP,~.C ~ /~ ~ S S COUNTY OF ~,,~..~......f ' .............. · .~..-.~~..~..~ .......................................... being duly ~wor,, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ............. (,W',',',',',',',~....~XtZ~r...~¢~.~ ....... ~. ................................................................................................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file qis application; that all statements contained in this applicaffon are true to the best of his knowledge and belief; end ~at the work will be performed in the manner set forth in the application filed therewith. yarn to bef¢~ me this ..... · .¢. ~tar¥ Pub I ic,~.~.., f ~:::~....~u nty ,, ~...x~.. ,&~/~. ~ .~. ~ .......... JUDITH T. BOKEN / (Signgfu.~ of applicant)