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Home My WebLink About7781-zTOWN OF SOUTHOLD 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? 7781 Z Permission is hereby granted to: C..o.~.~.~ ,....~. &T~.~. ~..~.P......~...C....~.~ ~,~..... [~atoZe oa ~ - lOth ~ve ...................................................................... ~eok~ ~o ~.~., ~.~..~.~.~ ~...g~.~.~ .................................................................................................. at premises located at ....~Z~..~...~.~..~ .......... ~ ............ ~ .................................................... ...................................... ~.~...~....~.~..~r..~.~. ........... ~.. ~.~.~b~.....~. ,.~. ~ ....................... pursuant to application doted ............... ~.....~1 ................... , I~.~.., and cpproved by the Building Inspector. Building inspector Approved .............. ~..! ............. ~./....., Disapproved a/c ....................................................... TOWN OF BUILDING TOWN ~LERK'S APPLICATION FOR BU/IL'DING PERMIT ~'~ ................................. /. ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sate 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 or 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 port 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..... (Address of' ~,~,ii~;;',~ ........ ~ ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ............................................................................................................................................................ Name af aw.er of premises axa. .l a-- ...... ............................................................................ 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 .......................................... '~'~' Ma No Location of Iond on which proposed work. will be do . - P .: ........... ~....-....-~...-.~.. ' ....................... Street and Number .............. ~,~-]~.'~.~.~-~ ...... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... .~....~...~..?..y.;/....j~..../~...~..~.....~..~..~...v....~...: ............................................................... b. Intended use and occupancy ........ .~....~.....~ ..................................................................................................... 3. Nature of work (check which applicable): New Building .. .. Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior. .................... Other Work .................................................... ~ (Description) 4. Est ima ted Cost ~.... ~y~..0..~.:.01l~. ................................ Fee .L~- .................................................................................. (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 ....... .0..k}..~¢¢.. ........................................................................................................................ 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 ~ntire new construction: Front ...... /~...~.. ....................... Rear ........ ./. .................. Depth .....~....C?..: ......... Height ....... .~. .......... Number of Stories ..................................................................................................................... /. 9. Size of lot: Front ............ t, ~, r'- .............................. Rear ......~...~....~'J..~...~......~ ...... Depth ....~..~..../..:..~..~.. ...... 10. Date of Purchase ..... I].C~...J.;~+..I..~.'7..-,~.. ............... Name of Former Owner ../..-~-_~.~:(~..~..~..(~i~.:.]~..q~.~ 11. Zone or use district in Which premises are situated ...t~(J~l.~...~./....~w~..Z.~..~..¥:...~,. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .../.............~....~.. .................................. 13. Will lot be regra;:led . ........ ..~.....0..:p~,~/r~ ~L/~ ~ ~,~/Will excess fill be removed from.7...~...~.:.ZO./~.~....,prernises:fl ). Yes (I/)/ No 14. Name of Owner of premises ~.u~.u.~.~.~.~.:w~..:~.w./3).~..~-~.~..v. Address Phone Name of Architect .............................................................. Address ...................... ':7 ...... Phone No ....................... (~OST" g' ~' /~ L¢".5' ( ...~..~.~..:.~.../.~f... ...... Phone No. Name of Contractor ..................~. ........... .~.....~: ...... ~ .......... Address PLOT DIAGRAM ~'/~Z Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWrY~OR~/~"C_ ~¢S ' COUNW OF ............................... ~.0~........~...~... ................ being duly sworn, deposes and says t~t he is the applicam (Name Ef individual signing contract) above nam~. ~ ~ 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 ~ke and file this application; that oil 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 fo~h in the application filed therewith. Sworn to before me this ~-- ~ 4 . '~ ;;; ;";i;',;;,' ............. ;:;.':;~:'::"~un;' ....... ...X..~~~.~ ............................... ~ ~ ~ (~ig~ature of applicant) ~a~m E~es ~ch 30, [~