The URL can be used to link to this page

Home My WebLink About8236-zTOWN 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? 8236 Z Dote ................................... , ... Permission is hereby g~anted to: at premises located at ................................. .'.~...~,..U...h.!...~.. ....... ..~,..~f.~ ....................................................... .............................................................................. [7!..~..~..~..~...U...C...J..~.. ........................................ pursuant to application dated ................................ O..C....Z:.....I.~ 1~...~...., and approved by the Building Inspector, Fee $.~ ..................... Building Inspector FORM NO. ! TOWN OF SOUT#OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~/~//'(~ ~ ~-- SOUTHOLD, N, Y. Examined ..................................... , 1~ ........ Approved ................... 19.~).. Permit No. "7--~-~ Disapproved a/c .............. ~ ~ ~.~_, ..................................... ........................................................... ............... .............. Application No ................................. APPLICATION FOR BUILDING PERMIT Date ........................ 19 .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 or areas, and giving a detailed description of layout ofproperty must be drawn oh 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 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 ir~ buildings for n~ece~spections.. /~ ( dress 6f app icant) State ~lther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .................................................................. Name of owner of premises ..... ~.~:~.~.~Z....~T....~.~..~.?~(~r~//~,~~ ................................................................ // // If applicant is a corporate, signature of duly auth~lzed office~/ (Name and title of corporate officer) Builder's License No. ~'~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ........ ; ...................................... 1. Location of land on which/~oposed work w~fl be do'~ Map No.: ..... ~ ....~ .............. Lot No. ....................... Street and Numbe, e.~.;..~Z.~......:..~d~ ................... ~.~.~:.~,~/_~.~c.. .................. Municipality 2. State existing use and occupancy of premises and intende, d~zd.~oc~upancy of proposed construction: b. Intended use and_occupan~cy .~//~..~/~..~..~.~-¢~..~-~.. ................ 3. Nature of work (check which applicable): New Building. ................. Addition ...~ ....... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... .~.~..~ ~ ~ (Description) 4. Estimated Cost ...~..~... ............................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling~pnits on each floor,r~ .......................... Jf garage, number of cars ...~=~..,...~ .......... r~......~~,.~...~..~.4%,M~ 6. If business, commercial or mixed occupancy, speci y nature and extent of eachJ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ..~.~ .......... Rear ....~'.., .~.. .................Depth .... ~... '.~..... Height ..¢.....~.. .......... Number of Stories ........... i../ ................................................................. .,. ...... ./.' ...... ,/...,,~,, ....... Dimensions ~f~s~.~ structure with alterations or~dditions: Front ......... ~..,c~.....'%. ........... Rear'S....~....~.~...../.'. ....... Depth ...... :~i[..~.(s~ .... Height ........ ~... .............. Number of Stories ............ ~.. ................. 8. ' /~' R / /2.---' Dimensions of entire new construction: Front ........... /(..¢ .................. ear ....../.¢.....~ .......... Depth ........................ Height ...... ..~O. ......... Number of Stories ....... j...4~-~-¢~ ........................................................................................... 9. Size of Io,: Front .......... /.~...~. ................................R~ar .........././~...4~. ..................... Depth ..... /....Z...~... .......... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ ~ 1. 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 .......~.~.~,yill e ~.%be removed from premises:,( ) Yes (~'~r~o 14. Name of ?wner of prem~,.~..~ ~7,¢rx=~ ....... Address~.. Phone Name or Architect ...... ~'~..-~.:.~ ~ ...... Address ................................Phone No ....................... Name of Contract(~~-~ ~..~.~-.;;_A..~.~.2Mddress~, Phone No ....................... Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all dimensions from ~roperty lines. Give street-~',nd bloc!,' '*;!mbcr~or description according to deed, and show names and indicate ~/hether interi°r °r c°rner I°t"~-)'2"~"~'3/~¢3/'~ ~' ' '~' ~ ' ~¢,--di~% , .................. ..//~~..~..%r,Z .............................. being duly sworn, deposes and says that he is the applicant · 4/Nome of individual Cgning contract) He is the ....~r.,~/4,~./. ............................................................................................... (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 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 forth in the application filed therewith. Sworn to before me this /) Nfofary I-'ui'.i~c L~ :: b.~ New York No. 52-97o3~25 ,%~folk County Corem, Expires Mar~h 30, 197~¢,