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Home My WebLink About8225-z FOI~M 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? 8225 Z Permission is hereby granted to: W:~.~.'-;~:~.,~,.~... :...~.;-~.~,.~.~..~,~,.-L~,'k.?.O.g,~:.~.~ ............. h,;~. ~ ~ ~o~ J. Soutbo~d ........... at premises located at .~./.~..~'~.J.~..£~Q~ .......................................... : ................................................ pursuant to application dated ............. ........~..q'J:;. ...... ~ .................. , 19..~..~.., and approved by the BWlding Inspector. Fee SJi,~Zg~, .............. -- Building-Inspector { FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Exom,ned ............. ........ , ,9..2.>:: ~proved ................... !~....~.~.. ......... , 19..~:Permit No. ~..:...~..:....-'~...,.~:../~ ~ ..~.~'"--. . Application No ............ .-.. ~i ............. Disapproved a/c ........... ..................... ........ ................. ...... APPLICATION FOR BUILDING pERMIT Date ...r~.~.:.!;...~.. ............................ , 19..'.~r~ ...... INSTRUCTIONS o. This applicotion must be completely filled in by typewriter o~in ink ond submitted in triplicote to the Building Inspector, with 3 set8 of plons~ occurote plot plon to scole. Fee occording to schedule. b. Plot plon showing lecotion of lot ond of buildings on premises, relo~tio~shil~ to odjoining premises or public streets o~ oreos, ond giving o detoiled description of Ioyout ofproperty must be drawn on the diogrom which is port of this opplicotion. ¢. The work covered by this opplicotion moy not be commenced before issuonce of Building Permit. d. Upon opprovoI of this oppli¢otion, the Building Inspector will issue o Building Permit to the oppli¢ont. Such permit sholl be kept on the premises ovoiloble for inspection throughout the work. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupanc~ e. shall have been granted by the Building Inspector."~ APPLICATION IS HEREBY MADE to the Building Deportment 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, as 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 applicc~nt,-'6r name, if a corporation) ..3,?.::.i .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If ~applicant is a corporate, sigr)pture of dul~ authorized officer. (/ - ~ , ~ ~ ' ~ / ~ ., , ,.::';., . . .:,. .,:,:,. ......... ...). .............. ~z' ~ (Nar~e a~id title of corporate officer) Builder's License No. ~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ ,(~x. I. Location of land on which proposed work will be done. Map No.: ....................... ~ .....Lot No .................. Street and Number ...... ~..~.~..~. ....... ~ -- --~.~O~....~.~::~.¢~A~... ....... ........ ~ ~ '~ ~~¢J~.__ ............... ......i ............. Municipality 2. State existing use and occupancy of premise, s, and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................................................................................................................... b. Intended use and occupancy ...:.~.:.~.~..(:..f?.:-..?~.: ...... ...c~.. ......... [ ...... ..C~..~ ................................................. O 3. Nature of work (check which applicable): New Building.. ...... ~ .......Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ,~ , I~* (Description) 4. Estimated Cost ...?..J...~.~.~ ............................................ 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 ................................ Rear .....~ ..................... Depth 8. Dimensions of entire new construction: Front ......... ~..~. ....................... / Height ..... I~;] ........... Number of Stories ........................................................................ i...~ ........................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........ ~ ............................................... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... W~II excess fill be removed fro~ premises: ( ) Yes ( ) No 14~.,.,,,j~dqcne of Owner of prem ses .,~¢.~;~\¢.t~[ : t.:(I,/4[¢~. 1. Addrf~,,~,-~,,f!J.~ ~. .. Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................. !Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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 NEW~ YfBK I ¢ ~ COUNTY OF ........... ....~..~.~ .................... / ........................................... being duly sworn, deposes and says tha~he is the appiicam (Name of ndiv dual s gn ng contract) above named. ~He is the .~J...~..~.~~..~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of soid owner or owners, and is duly authorized to perform or have performed the said work and to m~ke 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 fo~h in the application filed therewith. Sworn to before me this .......... ~ ...... day of .~.~.~.___~__ ......................... , 19..~.._,/'//7 , /, ....................... .......... Co,, .................................................. ~/~. /) , ~ ~ VX ,, . ,/ / (Signature/of applicant) J [H/ABF~I ANN NLVH. L[ I / NOTARY p[ff~t lC, S[a~" ,f New York