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Home My WebLink About7837-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, I',1. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7837 Z Permission is hereby granted to: Building Inspector. Fee $....../.,~, .~..~ ...... PERMIT INCLUDF3 AFF;',C ',.. TO REMOVE EXCESS f"LL FROM ABOVE PREN,'d~E:5 ,L f REGRADING LOT DP, tV'iWAY CON_TRUCTi~N CESSPOOL CONS (RUCTION CELLAR CONSTRUCTION OTHER Building Inspector ~_IX)WK OF SOUTHOLD .... IUILDING~ DEPARTMENT /////~ ~ ~ ~ ~-~ ~ TOWN ~.LERK'S OFFIC:E .~/-.-, .~ INSTRUCTIONS a. This applica'don must be comp!etely filled in by typewriter art in ink and submitted in triplicate to the Buildingl Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. ' b. Plot plan showing location of lot and of bu dings on premises, re ationship to adjo ning premises or public streets areas, end g v ng 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 Qr. 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 Occuponcy~ 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 regul,a~qons, and to admit authorized inspectors on premises and in buildings for necess~a~ L' I (Si~~ptt~t, or name, if a corp~i~i ....... 1~,1,~......~4,..;~, ~.e., ..~,~eh~.~ .:A,~.r ..~.~.~g, ....... ~aaress or applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises~il...al~..~e[[~:l,...~e,~lel~aell ............................................................ 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 ............................................... 1. Location of land on which proposed work will be done. Map No.: ....... .~.~*j~. ...................... Lot NO ]~0~ ................. Street and Numbe~.~.:...~.t~i.....~l~.~,...~&~,.~l.~ele .................... .: ....... , ~... 2. State existing use and occupanc}; of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ~ Intended use and occupancy ............... . .................................... 3. Nature of work (check which applicable): New Bui!ding 7 ................ Addition .....~, ....... :.. AlteYatJ'on ...~,...,~h,, RepCr .................. Removal .................. Demolitior ..................... /Other Work ..................................................... ~ ¢ (Description) 4. Estimated Cost ...... ~gJJJJ~0JJ ............................. Fee ....~,.~. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .,~ .............. Number of dwelling units on each floor ...Ol~..~J.~J~.. If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~j~,.j~l~l. ....Rear ...~1~ ..................... Depth ..~.! ........... Height ...~&'~.~..~..~. ....... Number of Stories ...... JJlt&.~l~J~l~t ..................................................................................... Dimensions of same structure with alterations or ~dditions: Front .... .~1~.I. ........................ Rear ....Jj~.l..~ .............. Depth .J~.l.][~,.I...~-~?.~,~eight .... ;.JJtlllllJ.., ......... Number of Stories ..... ~1~ ................... 8. Dimensions of entire new construction: Front ..~.l. ........................... Rear .....~ILI. ................ Depth ..~J~J~. ......... Height ..:.~.?.1~ ........ Number of Stories ..~ .......~ ........................................................................................ ~ ......... 9. Size of lot: Front .~.....'l~JJ~..~. ................................ Rear ..... .~e.~.I. ...................... Depth ...~-~,.~.~,~.~.~w?~l 10. Date of Purchase ......... ~J~.~.. ..................................... Name of Fo~mer Owner 11. Zone or use district in which premises are situated ...................... J~jJj;J~!J ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ,~, ......................................... 13. Will lot be regraded .........~. ................ Will excess fill be removed fr. gFi, pr~is~.sz (.v')'~'.yes ( ) No Nome of Architect .............................................................. ~ddress ................................ Phone No. ...................... Nome o( Contractor ............................................................ Address ................................ Phone No ....................... Locate clearly and distinctly all buildings, wheeher existial~ el' lll~llml~ ~ ell~ ~ .from property lines. Give Street and block number or descriptic~ ~ te Ill,Id, and ~ ~ mJmelond Indicate whether interior or corner lot. .201 PATIO '04. E$° N. 77'2~' E; STATE OF NEW YORK, [ c c COUNTY OF .... ,A,/'..."..-'~ .............. ~ -"'" ...... ........ .................. (Nome of individual signing contracO above named. N RUTH ~OA PLOT ' PL.AN 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 make and file this application; that all statements contained in this application ore true to the best of his~owledge and belief; and tha~ the work will :be performed in the manner set forth in the application filed thereWith.~--~ Sworn to be~f~Le me this // ~ ......... of ...... ........... . _ Nota~ Public~~..~,..~..~.~r Coun~ ..................... ~,..,.~ ........... % ........... ~----~ ~ ~~ (Signature of applicant) KANTLI~ ~ ~o. 41-292925S /,5'.3'. 7g ' ! , ' %, ~ I i I eUTH ROA~ -'i ? ~ I! PLOT PLaN , ~ ~ DI NItNG PM, KITCHEN 5,R, CL. C , ~ ' I I APPROVED AS~OTED - Iff~- I0"~" ,, "~ , , , ~' , ,, , , , , ~, ,, , jl