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Home My WebLink About8241-z FOF~ NO. ~ TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8241 Z Dote ...................................................... , i y ........ Permission is hereby granted to: at premises located at ~ '4 &~ C'~/C,q ~J) ~ t//C pursuant to application dated Or ~ IV l~...~iZand approved by the Building Inspector. Fee $....[..~.. .............. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMIENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom,ned ..................... ,e~proved ................... ~..-~..~.4., 19,~..~..~.~.. Permit No...~....~...~....!.~.. Disapproved o/c ..................................................................................... ( u'd' g pea) Application No....~....~....~../../. .............. APPLICATION FOR BUILDING PERMIT Bate ....................... ..~.....~.~.Z ....!...~...., 19Z?~ .... IN~STRUCTIONS a. This application must be completely filled in by typewriter ac 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 buiMings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram Which is part of this application. c. The work covered by this app!ication may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 <3 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 necessary inspections. ~ (Signature of applicor{l~, or name, if a corporation} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~me o~ owner o¢ premises 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. Mop No.: ........................................ Lot No ......................... Street and Number ....... .~...Ur.....O.;.~.......,-~.7~.~i.~....~.. ...... ~'"~.,~..,V,.~...~ ......... ..~.....~...~!.,,T.?...(../..~. ......................................... Municipality State existing use and occupancy of premises and intended use and Occupancy Of proposed construction: o. Exisiting use and occupancy ............... ..~....~..~ ....... ..~....~....~...L...~...!..~?.!...~... ........ .~......~.~.I.~.~. ................................ b. Intended use and occupancy ............ ~....A..~.!~'~ ......... ..~..!..T'...~ .......... ..~'~.~...~..J~.~C:T'.~ ............................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .~.~.. ~ J~/~__~ E.- -o ~ (Description) 4. Estimated Cost ................... /. ....................................... tee .......................................................................................... (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 ........................ '---" ~-.'.~...~...,u...~-~. ............... Rear .......................................... Depth V~ 10. Date of Purchase ............................. /~.~.....~.....~. ............ Name of Former Owner ........................................................ 1 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 ............................ Will excess fill be removed from premises: (,_) Yes ( · _qN TN- ~Z~E/~'TCSAI~L-- ~A-~,~i~_ u' 14. Nome of Owner of prem.ses .................................................... Address ................. ~'..~......~Phone No.~....~.....~...~..~..~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street ond block number or description according to deed, end s[how street names end indicate whether interior or corner lot. / STATE OF NEW COUNTY OF (Name of individual above named. being duly sworn, deposes and says that he is the applicanl 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 all 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 beEore me this ~ _ ---'" ................. ................. ~' ' ' / / (Signature of applicant) JUDITH T. BOKEN No. 52.1~?~449,,,3 Suti~lk