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Home My WebLink About8238-zExamined ........................................ , / / Approved ................. TOWN OF SOUTHOLD BUILDING DEPARTMENT Town C,E..'S omc ~UTHO~D, N. Y. l~l..:...y" Permit No. ' ' Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ipk and submitted in tripJlcote to the Building '~ nspector, with 3 sets of plans, accurate plot p an to scale Fee according to schedule; b. P at p an showing ocation of~ at and of bu Id ngs on premises, ~'e ati0nship to a~ljommg premises or public streets os 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 Pea'mit 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 in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Buildin APPLICATION Building Zone Regulations, for th The applicant a! admit authorized EREBY MADE to the Bull. of the Towel of Southol construction of buildin to comply with all on premises State whether applicer Name of owner of if applicant is a corporate, signature of duly for the issuance of a Building Permit pursuant to the unty, New York, and Other applicable Laws, Ordinances or or for removal' or demolition, as herein described. code, housing code, and regulations, and to ¥ inspections, ..... .... ............ -~(Sign~ature of appl cant, o~'name, f a corporat on) ........ .......... ...... (Address of applicant) / agent~ architect, engineer, general contractor, electrician, plumber or buiJden~ officer. (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 proposed work will be done. Map No.: ..~. .................................... Lot No../~.'. ..................... Street and Number . .:..~./~,~..'?.J....,O...7.'./.'L.,..~.::.~4~....,d~.~ ..... .¢~.~--~..~:q./.~..~.~...~.~. ..... D.A~/..~;'~.L ......................... Municipality 2. State existing use and occupancy of pr~)~j~nd~in~t~e;ded use and occupancy of proposed construction:. o. Exisiting use and occupancy ....~.~~:,~,~.]..,.: ............................................................ b Intended use and occupancy ............. ~?.../~.~..~ ~. ~.i. ~ ................................................................. 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) N9 8238 Z Date ...................................... /.., ] ... Permission is hereby granted to: ..~.!.~.!i~.~...Y. ........ ~:~ ........ f:'.,, zL,'3...v. ~..~._s ............... ~' at premises located at ..~.,.?...,,..~...J.P.I~.!.?...~.....E...-. ..~L.~..b!.7: ........ .a~,.A.~.. ................................. pursuant to application dated ................................ O~...-/......I.L/....., 19.~,..., and approved by the Building Inspector, Fee $..J. .................... Builkling Inspector / 3. Nature of work (check which applicable): New Building' ,~..,~...,,~: ...... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work .................................................... (Description) 4. Estimated Cost ..~.,.Z.~***.~**..~.~ .................................... Fee .., r// , (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dweiling 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 ....... ~. ............................................................................................................ Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................Name of Former Owner ........................................................ Zone or use district in which premises are situated ...... ~.....~/.¢i..~.. .......................................................................... Does proposed construction ~iolate any zoning Iow, ordinance or regulation: ~..~. Will lot be regraded . ....... '~//~.:..~ .......... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of ,rem.s se,,~sJ~'..~.'.'.,"/f..~.~.~.~.. Address .,;~.' _~,...A~.. ',~..~ ........ Name of Architect ....................... .J.. .................................. Address ...... ~..~..z~..~..~....,. ...... Phone No ....................... Name of Contractor ........ ~.: ........................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly 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 ~ndicate whether interior or corner lot. 10. 11. 12. ,,I3. 14. STATE OF NEW Y~ORK/ :55 ~, I ¢ ¢ COUN'F¥,OE ..... 'L'...,....-z...;....!.L..../,-'- ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow; named. He is; the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor/he work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ....................................... "'*'" /' -'./ Not, ory Public, . ............ ........ !..~......' ..................... County ' · -- ~ t (Signature of applicant) ELIZABETH ANN NEVILtE